Monday, November 16, 2009

How do I get my dental insurance to process/pay my claim?

I have dental insurance through WellPoint Dental Services. I needed a dental procedure and my dentist filed it and I received an approval/precertification from WellPoint in the mail. It said the insurance would pay $204 of the procedure. I had the procedure 4/25/2007. I paid my dentist in full (that's how he does it) and have been trying to collect the $204 ever since. I have called the insurance co and am always told it is in process. I have written 2 letters with a copy of the precertification to the address on my card and have had no response. On 7/18/2997, a rep said that it had been misfiled, but it would be sent to claims immediately and that all the necessary info was there. I have received no response to my letters, no check. What should I do now?? That procedure was $1000 and I could really use the $204. Thanks for any help!

How do I get my dental insurance to process/pay my claim?
Write a polite letter of complaint to the Commissioner of Insurance for your state - at your state capital. Copy to your insurance company's Vice President of Health Insurance Claims - or some similar person. The insurance company is required to respond to the commissioner within 30 days. Every day after 30 that they are late, costs them $. You should get a prompt response. But, remember to be polite. You will still have the same insurance company. Most claim adjusters are over worked but real people.
Reply:I would write a letter to your state insurance department - including the dates, etc, and file a complaint. And carbon copy in Wellpoint.

That should kick them into gear.

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