1

I just got new insurance and they cover orthodontia as of December 2022. However, my braces were put on in October of 2022. The braces cost $5,500 and I have already paid $3,000 of this cost. I called my orthodontist and updated my insurance and they billed my new insurance. Except they billed it as October 2022 and for the full amount… wouldn’t they be able to bill it as current and for the remaining $2,000 I owe? Or must they bill it this way?

2 Answers 2

5

I just got new insurance and they cover orthodontia as of December 2022.

That means you have coverage for procedures performed on or after the data your coverage started.

However, my braces were put on in October of 2022.

This is the date the service was performed. This date is before you had orthodontia coverage.

The braces cost $5,500 and I have already paid $3,000 of this cost. I called my orthodontist and updated my insurance and they billed my new insurance. Except they billed it as October 2022 and for the full amount

When a doctor submits a bill to an insurance company they always provide information about the procedures performed, the dates of service, and the full cost. The insurance company then pays out according to your policy rules, and the rates they have negotiated with the providers. The insurance company would then tell you what you owed as deductible/co-pay/co-insurance. If you did have coverage and had over-payed your portion, then you would get a refund. But if you don't have coverage...

3
  • Hmm. I do have coverage of 50% with no age restriction. I found that the policy states it would pro-rate the cost if they were put on prior to coverage. I suppose it might be the way they billed it. Commented Feb 15, 2023 at 13:37
  • 1
    Ask the insurance company for an explanation, if you really think it should have been covered... But normally you are covered only for events occurring during the period that you're paying to cover, so this sounds like the right thing happened.
    – keshlam
    Commented Feb 15, 2023 at 16:40
  • "I found that the policy states it would pro-rate the cost if they were put on prior to coverage." - Possibly that means your insurance company is interpretting the procedure as being continuous rather than point-in-time. That's very generous; usually such an interpretation is only applied if it's in the insurance company's favor.
    – Brian
    Commented Feb 17, 2023 at 14:09
2
  1. Insurers only pay for treatment within the dates of the plan, specifically after coverage has begun.
  2. Providers are required to date the bill on the date the service was provided. Not doing so would be considered fraud.

Your insurance that commenced in December 2022 will not pay for any services provided in October 2022.

If that were not the case the insurance companies would be laying themselves open to a huge scam, in which you pay no insurance premiums, but as soon as you get a big medical bill you take out the insurance and claim the cost from the insurers. Obviously this loses money for the insurers and so they won't do it.

You must log in to answer this question.

Not the answer you're looking for? Browse other questions tagged .