Medical procedure coverage and denied claims

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Is this grounds for small claims court?

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Sure. Better call Saul.

Do you have a deductible?

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lets say a Dr's office tells you a procedure is completely covered by your insurance...then begins billing you for the procedure because the insurance denied coverage. Is this grounds for small claims court?

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It should be

Drs office says there was one done...and patient was notified verbally this was covered. Patient never signed a financial consent form bc of that...is the Drs office completely screwed or what?

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Just because it's covered by insurance doesn't mean you won't have to pay anything, especially if you have one of those big arse $5600 deductibles

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Yes. Also verification of coverage does not mean you will have no responsibility, it simply means the insurance company approves of the procedure. Then they adjust the billed amount(s) and make determination of who pays and how much.

Says the procedure is experimental

Call the Drs office and ask them what CPT code was billed and what diagnosis/ICD-9 code was billed. With the info from your Drs office call your insurance and speak to someone in the claims department. Ask them why the claim was denied, the CPT/procedure code or the diagnosis code. Usually when a claim is denied by the insurance as experimental it's because the wrong code was billed whether it was the actual procedure code or diagnosis code.

Take the day off work, as this will take hours and you'll talk to atleast a dozen different people.

My wife went to one of those chain dentistry places for a checkup. They asked her about having sealant work, and claimed that her insurance would cover it 100%. She agreed to go ahead and have it done, but a month or two later we get a bill for $1,000.

After talking with the insurance company, it was very clear that they would not cover it at all. We called the dentist's office, and they pulled up the info again showing coverage. After a little back and forth with their corporate office they tried to deal with us and cut the bill in half.

We refused to pay, and didn't hear anything again until a claims company contacted us after almost a year. My wife emailed the office manager about it, and she was then CCed on an email to the corporate billing department about their error. We also decided to file a claim with the BBB.

By the time the BBB followed up with us we received a letter saying everything had been settled. The weird thing is that supposedly the office manager got in trouble for the email. Even weirder is that when researching that dental company, they had a lot of similar claims against them.