Payment disallowed because of late submission.

[Drimadeon]

What is the name of your state? Virginia

This is for a claim submitted to Delta Dental. (I hope this is the correct section for this question. My apologies if not.)

My daughter received braces on 5/29/2003. The orthodontists bill was 1390.00 which we paid in monthly installments to him for 1 year. After completion of these payments, we submitted a claim in Sept, 2004 to Delta Dental since we had a 50% co-pay for this service. Delta Dental responded with:

"Processing Policy Explanation: 18 - Payment disallowed because of late submission. Claims should be filed within 12 months of date of service."

I find this unacceptable. 50% of 1390.00 is 695.00. Do I have any recourse? And if so, will it be worth my while?

Thanks in advance.

Michael

 

[JETX]

Do I have any recourse?

Obviously, no one here can answer without reviewing your policy, but it appears that you do not.

And if so, will it be worth my while?

See above.

 

[cbg]

For most, if not all, dental claims, the date of service is considered to be the first day of service, which would be the day the braces were put on. You should have submitted the claim to Delta then, and NOT waited until the work was complete.

I guarantee you that if you look at your dental policy, you will see that explained.

It is by no means unusual for an insurance policy to have a limit on when the claim can be submitted. I promise you that this information is in your policy as well.

While I obviously don't know what your specific policy says, if your policy has a 1-year limitation, then you have no recourse.

Next time, read your policy. That's what it's for.