Getting 100% of What the Doctor is Owed

February 15, 2021

By Bella Zaritsky

I had a Delta Dental claim that was for four impacted wisdom teeth with IV sedation.

The Initial Claim Submission

It was initially sent to Delta, but Delta required a medical EOB for these specific procedures. The medical insurance took 4 months to process the claim and send the denial for all services rendered on that date of service. I sent the dental claim, along with the medical EOB, to Delta Dental for processing.

Partial Payment and First Reprocessing Attempt

Delta remitted payment for one of the extractions, but nothing more. I called and spent over an hour on the phone explaining what had happened, and the representative finally agreed to send the claim back for reprocessing and promised it would be paid correctly this time.

Continued Issues with IV Sedation

When the next check came from Delta, the EOB showed the remaining three extractions, but did not include the IV sedation. Another long phone call, over an hour and a half this time, explaining that the IV was not paid.

Escalation and Additional Payments

A few weeks later, another check comes from Delta that includes two of the four units of IV. A third, and 2-hour, phone call to a Delta supervisor, and the final check was issued for the remaining two units of IV sedation.

Final Outcome

The claim was completely processed 6 months after the procedures were performed.

Talk about “pulling teeth” to get a claim paid!

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