John Galt III
Thinks s/he gets paid by the post
- Joined
- Oct 19, 2008
- Messages
- 2,802
I'll give a synopsis here first. I'm having a new crown put on. Insurance co sent me an EOB saying the are approving nothing yet, and are requesting 'please resubmit with narrative of medical necessity'. Dental clerk says not to worry, she will handle it. Complication is that the same tooth had a filling that only lasted a month, then I opted for the crown. Don't know if that is a problem for the claim.
Whole post follows : I just received a scary EOB for a scheduled crown. I haven't even had the crown put on yet, but the dentist apparently has already submitted the claim, for tooth buildup ($385) , and the crown itself ($1,050). It says I owe 100% of the charges at this point, not even a reduced amount.
But... a remark on the EOB is requesting the dentist to 'please resubmit with a narrative of medical necessity'. So it's not a denial, but a request for documentation.
Some background. The tooth getting the crown had partially cracked off. The dentist wanted to do a crown, but I asked about a filling instead, and he agreed to try it, but said it might last for years, or might not.. The filling came out after a month, and I went back and requested a crown. The insurance co paid the claim for the filling, no problem.
I called the dentist's office about the request for 'narrative of medical necessity' and the clerk said this particular ins co does that sometimes, and not to worry about it, and that she would have to write a letter to them. She said she had not received the EOB yet, saying the mail service is often late there. (Same zip code I'm in though, so why is her mail late?)
Maybe the insurance company thinks I ought to just get another filling? Too late for that. Already had the tooth buildup for the crown. I called the insurance co and asked about the crown claim, and they said they will 'make a decision' when they get the 'narrative of medical necessity' and also want an xray taken within the last 6 months. I couldn't get a reason out of the guy for the xray, but I assume it's to show the cracked off tooth needing the crown. But an xray 3 months ago would show the tooth before it cracked, so I just don't understand that 6 month window. There's no mention of an xray in the EOB. Fortunately, the dentist did an xray when he put in the filling, and another xray when doing the crown buildup. If they want an xray showing a noncracked tooth, I have to go back to a year ago or more.
He didn't say anything about the filling, and I didn't mention it. We only talked about the EOB for the crown. I'm wondering if the insurance co has a problem with the fact that I tried the filling first, and that now they have to pay for a filling and a crown on the same tooth. I thought about postponing the installation of the new crown, but now I think I will go ahead and have it installed on the scheduled date, with or without the claim being approved yet, since I need it anyway.
Are dental insurance companies into denying claims for crowns these days? Is the filling in the same tooth a problem? Or is the dental clerk right, that I don't have to worry? Thanks for reading this long post. Any input appreciated!
Whole post follows : I just received a scary EOB for a scheduled crown. I haven't even had the crown put on yet, but the dentist apparently has already submitted the claim, for tooth buildup ($385) , and the crown itself ($1,050). It says I owe 100% of the charges at this point, not even a reduced amount.
But... a remark on the EOB is requesting the dentist to 'please resubmit with a narrative of medical necessity'. So it's not a denial, but a request for documentation.
Some background. The tooth getting the crown had partially cracked off. The dentist wanted to do a crown, but I asked about a filling instead, and he agreed to try it, but said it might last for years, or might not.. The filling came out after a month, and I went back and requested a crown. The insurance co paid the claim for the filling, no problem.
I called the dentist's office about the request for 'narrative of medical necessity' and the clerk said this particular ins co does that sometimes, and not to worry about it, and that she would have to write a letter to them. She said she had not received the EOB yet, saying the mail service is often late there. (Same zip code I'm in though, so why is her mail late?)
Maybe the insurance company thinks I ought to just get another filling? Too late for that. Already had the tooth buildup for the crown. I called the insurance co and asked about the crown claim, and they said they will 'make a decision' when they get the 'narrative of medical necessity' and also want an xray taken within the last 6 months. I couldn't get a reason out of the guy for the xray, but I assume it's to show the cracked off tooth needing the crown. But an xray 3 months ago would show the tooth before it cracked, so I just don't understand that 6 month window. There's no mention of an xray in the EOB. Fortunately, the dentist did an xray when he put in the filling, and another xray when doing the crown buildup. If they want an xray showing a noncracked tooth, I have to go back to a year ago or more.
He didn't say anything about the filling, and I didn't mention it. We only talked about the EOB for the crown. I'm wondering if the insurance co has a problem with the fact that I tried the filling first, and that now they have to pay for a filling and a crown on the same tooth. I thought about postponing the installation of the new crown, but now I think I will go ahead and have it installed on the scheduled date, with or without the claim being approved yet, since I need it anyway.
Are dental insurance companies into denying claims for crowns these days? Is the filling in the same tooth a problem? Or is the dental clerk right, that I don't have to worry? Thanks for reading this long post. Any input appreciated!
Last edited by a moderator: