Insurance Denied Part of Claim but EOB Say’s Otherwise

Hello All,

Hope all is well. Well the title might not explain the best because this is confusing as hell.

So I've gotten wisdom teeth extraction 2 months ago on June 27th by an in-network surgeon. Before I even got the surgery I made sure everything was covered by speaking with a rep. The procedure was for all four wisdom teeth to be removed with deep sedation/anesthesia. Well I'm just NOW finding out that the whole claim was originally denied and then reprocessed two days later. I received my EOB (from United HealthCare in Maryland) just last week and here is the summary.

Amount Billed-$4,679.00

Amount Allowed-$1,055.00

Plain Paid-$955.20

Your responsibility-$99.80

Here's the kicker… I received a bill from my dental provider that say's I owe 485.20. So I call early today to speak with my insurance (btw I don't have the insurance anymore) the rep at my insurance first say's that I should only owe what's on my EOB, she then calls the dental office and the dental office is saying I owe for the deep sedation which in total is the 485.20. Again, I called before the surgery to confirm the pricing and it was supposed to be paid at like 80% The rep then tells me that she didn't see that it was denied by my insurance, and that it's denied because no narrative was provided. I didn't receive a letter stating that it was denied, only the INITIAL deny before they reprocessed the claim and the EOB from Sep 31st. I wasn't prepared to pay this as I already thought this was settled.

See also  Overpaid hospital. What should I do?

Also, I had to pay a 20% security deposit of the estimated patient responsibility and then had to pay the rest of the estimate the day of surgery. Does anyone know if this goes towards the total? The insurance rep just said I should've did a pre-authorization before surgery but I thought that was done before surgery. This is all too confusing to me, I'm sorry for the long post.

Does anyone have experience with this? All help is appreciated.

submitted by /u/ExamplesMadeof