My "In-Network" dentist performed my tooth deep cleaning and charged me deductible and eligible out of pocket upfront before cleaning.
The claim submitted by the dentist got rejected citing this:
"295 – BASED ON THE CLINICAL DOCUMENTATION REVIEWED BY OUR DENTAL CONSULTANT, SCALING AND ROOT PLANING DOES
NOT QUALIFY FOR BENEFITS DUE TO THE ABSENCE OF RADIOGRAPHIC EVIDENCE OF BONE LOSS. A PARTICIPATING DENTIST MAY
NOT CHARGE THE PATIENT FOR THIS SERVICE. TO REVIEW OUR CRITERIA, VISIT THE DENTIST SECTION OF OUR WEBSITE"
Now I'm unsure whether the dentist office will bill me the full amount since insurance denied it. But they are In network with Altus and the EOB says in network dentist may not charge the patient and states the patient responsibility $0.
I'm very confused will I be sent a big chunk of bill or will I be refunded my upfront payment since EOB says they can't charge me.
Anyone please shed some light on this?
Altus dental denies claim citing absence of evidence
byu/Massive_Distance9111 inInsurance
Posted by Massive_Distance9111