AnsweredAssumed Answered

Using Secondary "In Network" Benefits? Legal Question

Question asked by Aka257113449546 on Aug 14, 2019
Latest reply on Aug 14, 2019 by communitymanager

So I am currently pretty livid, I have spoke with two separate Humana rep's and of course the Dental office itself. I have 2 Dental insurances. Humana is my secondary insurance plan, and IN network/PPO provider for the dentist I used. The Dental Office made me pay the "expected amount" insurance would not cover ($886.60) so I paid up front expecting to be reimbursed due to the "In-Network" plan. So after waiting a month and a half I finally receive my claim information from Humana stating it is complete! My app states, "My Share" was 26.77 after both insurances paid and "In-Network" deductions "Yay!" I think to myself THANK GOD. Well fast forward, I was given a reimbursement check for 127 dollars. So, pause. How in the world did we go from me receiving almost ALL of my money back to not even close to half. WELL according to the incredibly rude office manager, and the Humana representatives phone call. It is the OFFICE'S DISCRETION to abide by in network benefits for Secondary insurance! So out of a total bill of 1,873.00 Humana paid $2.40. WHAT is even the point of having Humana as a secondary if you aren't required to enforce the contact you signed for in network? I truly would appreciate if someone could verify the truth behind this statement for me because in that case Humana is useless. So my question is, is this legal? Now that I am screwed out of almost a thousand dollars is that due to Humana being obviously lax with their contract or due to the dental office being greedy?