the auth was only good while you were enrolled, if you had work done after you terminated coverage you are on the hook for it
Posted on 07/05/2016 7:39:00 PM PDT by George from New England
For five years now I've been on my wife's health care plan. It includes dental. Back on March 23rd, 2016 at a dental visit they discussed a crown on a tooth in my mouth. To get the preauthorization they took an x-ray. They submitted and was told they needed a different kind of x-ray. Time passed. In late May I suspected that I might be dropping coverage end of June this year. So I revisited the crown in a conversation with the dentist office before Memorial Day. They took my call and apparently resubmitted the pre-auth request. No new x-ray taken. On July 2nd I received in the U.S. mail the grant of this (over 90 day old) request for crown work.
Now my coverage stopped June 30th. $800 down the drain. $Is this legal or not. State is Florida. uhc is the management firm. Employer is the doicese of St. Petersburg.
Do I have any recourse?
This is not directly related to yuor situation, but switch to Delta Dental. Never had a problem with them or finding a dentist who accepts DELTA Dental Insurance.
I would check the Summary of Benefits for your prior plan to see how long authorizations are supposed to take and if these services can be retro-reviewed. Given that you dropped coverage, this may be your best bet. You could also file a formal complaint/grievance with the Florida State Board of Insurance or other governing body. In your letter, keep to the facts and supply any documentation regarding the denied charges.
Good luck.
Delta Dental ?!? We couldn’t wait to unload them. We spent more time on the phone with those people than we did in the dentist’s office. The dentist’s office had to resubmit every claim repeatedly. Delta Dental was a nightmare for us.
If you voluntarily dropped coverage and waited until it ended to get the work done, it sounds like it should be on you rather than them. But check the policy.
the auth was only good while you were enrolled, if you had work done after you terminated coverage you are on the hook for it
United Health Care is notorious for denying needed treatment and delaying payment to dentist. They are the absolute worst. They use stall tactics to deny the insured the treatment they need and pay for. The treating dentist has to send multiple claims and jump through an inordinate amount of hoops just to get paid. Often 90 or more days after treatment is complete. Its ridiculous. I can’t stand them! Good luck!
Why didn't you continue it under COBRA? You still can you know.......
I migrated my personal coverage to a health care sharing ministry as of July 1st. No dental there thou.
Would you think I have a basis for suing the company itself (self-insured with uhc as management) for the last two months premiums as they did what they could to not provide the benefit. I could have gotten out April 1st if I had know that they were going to play this game with the dental benefit. There is a paper trail going back to March 23rd with the x-ray.
Just give me back the premium I paid, shysters.
Whatever coverage you lost you have the right to continue via COBRA.
You should be receiving a letter from your wife's employer informing you of your rights to continue any coverage you had thru them via COBRA. I would call the employer and speak with their benefits rep..........
We have been with Delta dental since 1986. Not a single problem. No dentist has ever complained about non-payment. And during these years we must have gone through 5 or 6 dentists. Problem might be your dentist and his/her crew.
Now my coverage stopped June 30th. $800 down the drain. $Is this legal or not. State is Florida. uhc is the management firm. Employer is the doicese of St. Petersburg.
Do I have any recourse?
No. Probably not. And who are you seeking recourse from? The insurance company - UHC Dental, your dentist, your wife’s employer?
Did you get anything in writing from UHC as to why the preauthorization back in March was denied or are you just taking the dental provider’s word for it? Why did you wait so long to revisit? It almost sounds as if your dental provider may have screwed up since you subsequently got the preauthorization without having more x-rays taken. Don’t automatically assume that the insurance company is to blame.
If your dentist resubmitted the preauthorization around Memorial Day and you received notification in the mail from UHC approving it on July 2nd, that’s only about a 30 day turn around which doesn’t seem all that unreasonable. But note the date on the approval letter. Also keep in mind that UHC when they approved, would likely not have been notified at that point that you were terminating your coverage effective June 30.
$800 down the drain
$800 for what? If you are talking about health insurance premiums (I presume at that amount, that this is the combined medical and dental premiums from March through the end of June? Or all the dental and or combined health and dental premiums you’ve paid over the last 5 years?) that your wife’s employer deducted from her pay?
But in either case, no - you likely have no recourse getting a refund of those payroll deductions from your wife’s employer. You technically had coverage. If you have a complaint against the dental insurance company’s handling of the preauthorization, what you are assuming to be a purposeful delay, that has nothing to do with the premiums deducted/paid nor does your wife’s employer have anything to do with that. That comes down to a possible complaint with the insurance company. But you voluntarily terminated your coverage effective June 30th so you are likely “SOOL” to receive services under the dental insurance plan after that date in which case your state’s insurance commissioner is unlikely to help you.
I migrated my personal coverage to a health care sharing ministry as of July 1st. No dental there thou.
You need to look at the COBRA notification you received or will receive, assuming your wife’s employer is subject to COBRA – has or had 20 or more employees. Unless the dental insurance was bundled together with the medical coverage (i.e. was your wife able to elect medical and dental coverage separately or was the dental coverage included with the medical plan?) - if not bundled, you can opt under COBRA to continue dental only coverage – the COBRA letter will explain this.
You have 45 days from receipt of the COBRA notification to elect continuation and another 60 days to pay the COBRA premiums and retroactively reinstate coverage back to July 1. But note that you will have to pay the monthly COBRA premium retroactively to July 1 and through the current coverage month.
But keep in mind that under COBRA, the premium reflects the full cost of premium, both the ER paid portion and the ER share. It can be quite the sticker shock to a lot of folks. The plus side in electing COBRA is that it is literally a continuation of the benefits. If you opt to purchase private dental insurance however, your dental coverage can be subject to a waiting period for pre-existing conditions. The ACA’s rules regarding pre-existing conditions does not apply to dental coverage.
“Do I have any recourse?”
If it hurts enough, pay somebody to fix it for you.
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