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Q: Coverage for widom teeth ?
asked by: noiseordinance on November 3rd, 2008
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Hi there, I'm going to start by saying that I am in college. The only reason I say that is to encourage someone to read this (by means of pity) and possibly refer me to a more proper place if this isn't a good place to ask this type of question.

I worked for a company that has Blue Cross for medical and ODS for dental. I needed to have my wisdom teeth removed, so I called Blue Cross who said that they would normally cover 80%, but if another insurance company is involved, would cover nothing. I then called ODS who said they will cover 80% of the entire procedure (two teeth and anesthesia).

I, like a dummy, told the dental surgeon office to bill only ODS. I paid over $1000 upfront, expecting a reimbursement. I just received a statement from ODS saying they have covered $0 of my procedure.

To make matters worse, I no longer work for this company that provided insurance. To be exact, I had the surgical procedure performed on October 10, 2008, and stopped working at my company on October 16, 2008, and both of my insurance provider's coverage ended on October 31, 2008.

Could someone please offer any type of advice? This money means everything to me. As a poor college student, the reimbursement money I had expected is enough to repair my car. Is all hope lost? Can I fight this? Should I call ODS and tell them they need to pay? Or do I call the dental office?

Thank you so much for any advice, or even a referral to a different forum if this type of post is not welcome here....
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rooted
replied on November 4th, 2008
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I'd suggest that you call the dental office and ask them to bill Blue Cross as your primary, so that you can re-coup at least 80%. Then, I suggest that you call ODS and bug them and FIGHT! Get both processes started, because now that you've paid, you're going to have to wait for the money to be reimbursed, for months!

Good luck!
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vorofco
replied on November 16th, 2008
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Noiseordance
You are eligible for COBRA. When you quit, you should have been presented with a packet for COBRA, yes you could have signed up then; however, the law allows you to wait (I believe) up to 60 or 90 days to sign up and pay our premiums.

Go into BC and tell them you want COBRA, your time limit is definitely not up. They will enroll you, you pay your past insurer for the premium not the Insurance carrier.

Once you are notified that your COBRA has gone through the process and you are back in the system, resubmit your bills. THEY HAVE TO PAY. The EMPLOYER HAS TO OFFER YOU THE COVERAGE and give them heck for being and insurance company and not supplying you with the papers. If they say it's too late, stand firm and tell them they better check their statue because you are within your legal rights.

I helped someone who didn't elect COBRA in the beginning. He had a motorcycle accident within 90 days (so I guess it's 90 days) He was comotose, etc and we got him enrolled and his family didn't have to go bankrupt.

Whether you elected COBRA or not, you have time on your side. Don't put it off.
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