Lay off during root canal

[dentalmags]

NC- my dentist informed me that I needed a root canal on my perfect looking tooth (which he had filled a cavity on 2 months earlier) . he said the tooth had to heal for two weeks before the white porcelain crown could be put on and that the root canal procedure would have to be done in 2 separate appointments. i was laid off 1 week before my second appointment to complete the root canal.
when i went to my annual teeth-cleaning, the assistant informed me that the insurance company denied the second part of my root canal. she said the insurance company treated the root canal as 2 separate procedures-not as 1 procedure. I did not understand why this was not explained to me during the root canal. the dentist implied that the root canal was 1 procedure but just 2 separate appointments. this dental office is requesting me to pay this huge dental bill. what is my defense?

thank you in advance,
dentalmags

 

[justathought]

Was the second appointment for the crown? If so, I don't think it was because of your layoff--crowns are usually cosmetic and unless your dental plan is real sweet, you're probably on the hook. (When you sign in, the forms you sign usually say if the insurance doesn't pay, you are completely liable.) I have yet to have a dental insurance provider cover the crown because it's considered cosmetic. (Although I'm still convinced this is a dentistry scam because I wouldn't have needed the darn crown if you didn't just hollow out my tooth!!)

When I showed up for the second appointment for my root canal, they informed me that the 2nd was for the crown and insurance would not cover cosmetic procedures. Of course, if I had known that to begin with, I would have just had the darn thing yanked. I left even after hey told me that the crown was absolutely necessary (oh boy did they argue) and the cement filling from the first appointment would only last 2 weeks (just enough time between appointments)... That was over 5 years ago!

Didn't know if you wanted a story, but bottom line is they always get their money because they provided a service that you agreed to pay for if insurance didn't... But again, this is personal experience--perhaps someone else knows loopholes or state-specific idiosynchracies that I don't?

 

[dentalmags]

any other suggestions?

NC.....Well, of course the dentist told me that the crown was definitely necessary. He did not give me the option not to get it. If I had known that the root canal was going to be treated as two separate procedures, I would have opted for something different. But they also told me that the insurance would pay. The dental assistant told me that the claim was denied because my insurance was no longer active during my second appointment for the crown procedure.

Thanks for your thoughts.....are there any more suggestions?

 

[cbg]

The problem with dental insurance is that almost all policies will not pay for anything that happens after the insurance coverage changes and they are no longer the carrier, but also will not pay for anything for which the work was already started prior to the start of a new policy. This is, as far as I know, a problem unique to dental plans; medical plans do not operate this way in the large majority of cases (there are exceptions). Unfortunately, it has the effect of leaving the insured out in the cold in situations like yours.

Try calling the state insurance commission and see if they have any suggestions.

 

[dentalmags]

NC- Great suggestion. I'll try NC insurance commission. Thank you guys for your help. I'm new to this message board and I think it's great to know what other people think and of their experiences.

Dentalmags