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Subject:  OON Health Insurance claim submitted too late Date:  1/28/2020  11:32 AM
Author:  DeltaOne81 Number:  18192 of 18222

My wife went to a oral surgeon for a painful issue last spring and he helped her out a lot. At the time I found them on the insurance company website and thought they were in network. The doctor was, and still is, listed in their app and doesn't indicate out of network anyway. When I compare it to my primary care dentist who I know to be in network, the screen looks exactly the same.

Unfortunately, the insurance company says they are out of network on the EOB their office didn't submit the claim for several months and the claim was denied for being too late. Since they are "out of network", I have received a bill from their office for the full amount. The doctor deserved to be paid, but it's completely crazy for me to have to pay because of their screw up.

It appears to be a medical (not dental) claim and as a medical claim would have been covered in full because we had already hit the 2019 max out of pocket for her.

What's my best course? An appeal with insurance? Does them appearing in network still help any? Negotiate with the doctor for some R&C sort of charge and swallow it?
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