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He said she said--Who's at fault?

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Old 06-15-2012, 02:13 PM   #1
Join Date: Nov 2011
Posts: 7
Alguy HB User
He said she said--Who's at fault?

I had an MRI done for my TMJD (temporomandibular disorder) symptoms. When I called the MRI office to verify my insurance coverage status, I was told that the insurance covered the procedure 100%.

A few weeks later, I got a letter stating that my claim was denied.
It turns out, when the medical office called my insurance to verify my benefits, they did not mention that my MRI was for TMJ, and my insurance does not cover TMJ related procedures.

I was not aware that MRI could be further specified into TMJ or other medical issues, so when I was told that my insurance covered 100% MRI, I went ahead and got the scans. Now I'm sitting on just less than $2000 bill for the scans.

Is the medical office by any chance at fault for providing incorrect or inadequate information to my insurance company for verification?

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Old 06-15-2012, 09:44 PM   #2
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Join Date: Jun 2012
Location: Atlanta, Georgia
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magicssd HB Usermagicssd HB Usermagicssd HB User
Re: He said she said--Who's at fault?

I am sorry to hear that. I am not sure how that will work out but usually when you have a procedure you have to sign for it and they have the typical small print that says that you are liable for anything that your insurance doesn't cover. I would try to see if your insurance will reconsider.

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