MetLife Billing Problems
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MetLife loses Tricare dental contract, this Reservist rejoices. Before deploying, I get a postcard informing me our family dental insurance had changed. Curious, I call MetLife. Yep, that means you were canceled for non-payment. Why? Autopay wasn't working, money didn't come out, my fault, no insurance for you. Fair enough. I pay premiums through end of MetLife contract (Hooray, and many thanks to whoever pulled the plug on them!) and head off for deployment.
What do I find on my triumphant return? A bill from MetLife for me -- not my family -- to the tune of $250 for premium payments extending back to 2015. After a quick call to United Concordia to confirm that I, a reservist on extended active duty orders, had been covered by them and NOT MetLife, I give our friends of MetLife a call. Service rep tells me I owe back premiums, I disagree, I spend some time on hold. Gosh! Looks as if that bill had been canceled, and I can just ignore it. Huh. "Were you going to send me something to let me know that I didn't have to pay that bill?" "Nah, we don't have the contract anymore, no further letters to be sent out. Good thing you didn't pay it, though", huh?
I also asked about the $100 bill for the family plan backdated premium changes. Seriously, no more info than that: you owe us some money. I pointed out that, given the other bill being entirely bogus, I needed more to go on than that. The service rep told me she'd have to look into the matter, and that she'd call me back. If I were a betting man, I'd plunk down a fiver that I'll never hear from them again. In short, if the manner in which MetLife handled billing for the Tricare dental contract holds for the company in general, avoid. Just stay away. Best case scenario, incompetent; worst case, outright fraud. I wish I knew the backstory to them losing the contract. I wouldn't be surprised to learn someone wound up in jail.
My husband converted his MetLife term life policy to whole life last winter. We paid our initial bill. Then we waited. And waited. And waited some more. Never got the next quarterly bill. Instead we got a late notice. My husband called, irate. MetLife supposedly mailed us our bill. We just never got it. A fluke? Maybe the first time. Since last winter we have NEVER ONCE received an actual statement. What we have received are 3 late notices. Last week (Jan 5th, 2017) we were once again waiting for our quarterly bill. My husband called and was advised it was mailed in NOVEMBER! They promised they'd mail another bill immediately.
One week later, no bill. I called, and was told by the CS rep that it was mailed to our address (I confirmed that they do have our correct address) and blamed it on the USPS. I am city mail carrier for said organization, and know first hand that (1) the mail can be slow and (2) the mail can be lost, missorted etc. But to blame for never received bills on the USPS was too much. I lost it. I could not believe that such a well known company would play the blame game and engage in finger pointing. I told her how disgusted we were, and that if we don't receive our bill by this upcoming Tuesday (Monday being MLK Jr day) we would immediately cancel the policy. Never again MetLife. Avoid at all costs. It's just not worth it.
I never received a booklet that I was suppose to get when I got this coverage. That being said, I had no idea that there was a max amount of $1300 for a spouse. I went and got my wisdom teeth out (the estimate showed my insurance covering the majority of the procedure) because they were starting to bother me and was uninformed that I had NO COVERAGE left, so here I am paying out of pocket for all 4 of my wisdom teeth getting extracted.
I sent a claim for dental services totaling $1,880. I sent the X-rays with it. MetLife refused my claim because they wanted X-rays which I had already sent and my dentist had sent separately. I called MetLife today and told them to look through my filings. When they did, they confirmed I had sent everything and would now process the claim. This happens ever single time that I send a claim other than the normal dental cleaning and X-rays.
For the last 3 years we have had challenges with metLife. I had 2 crowns applied almost 3 years ago, discovering after the fact (even though MetLife initially approved the procedure) that I was no longer covered. So we ended up reimbursing our dentist in full just a few months after we were PCSd. So WE paid a few thousand for 2 crowns. Fast forward 2.5 years. The crown popped out during routine dental hygiene in our current dentist office. The dental office staff called the insurance company in advance who told them that "they had no record of having initially paid for the existing crown." This led the dental office to believe the replacement crown would be approved and they went ahead and provided me with a new crown. Fast forward 7 months - we get a bill from the dentist saying that MetLife DENIED the claim. Hmmm.
When we called them, MetLife said that their policy is that a crown must last for 5 years and they would not pay for the redo. They also suggested we should have gone back to the original dentist. We pointed out that they didn't pay in the first place, we did 100%, and that we were PCSd over 1600 miles away from the original dentist. They said they would call us back after further exploring the issue.
A week later, we did receive a call back from MetLife and this is what they said: "their policy is that a crown must last for 5 years REGARDLESS of who originally paid for it" and would not answer our concern about having been moved by our military over 1600 miles away from the original service provider. And thats it. Again, they don't pay. So, if we WEREN'T in the military and hadn't had to move, we would've had recourse to return and perhaps have the crown repaired/replaced by the first dentist. MetLife is THE dental insurance company for the US MILITARY - we ALL move!!! How many other military families are being unduly affected by this GREEDY company??
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Our family was notified by family dental office that claims for our family members were not granted by MetLife. Long story short, MetLife rep told us there is "overpayment", so my whole family is put on hold for any claims. There is NO calls or letters or any forms of notice to us, even after we have been calling them for status over last 2 months. How could a company stays in business like this? Who do you think they are? Just simply stop all payments and no notice to us! All past calls of 5 times include supervisor just give simple answer - all claims on hold until overpayment cleared. But gives no explanation when and how to clear up. Surprise to see here so many complaints about MetLife, now I know why.
GREEDY company that uses any opportunity to avoid paying. My daughter is in college overseas and can only come for cleaning during her breaks. MetLife of course has no coverage overseas. So we asked that instead of applying 6 months rule between cleaning they would authorize twice per year cleaning, so she could get one service slightly earlier during her Christmas break. But they refuse to budge. So this means that even though they collect premium payments for the service, we only are covered for one service per year, and have to pay additional $140 for the second service ourselves (although it means only one month difference in their calendar). They also don't cover tons of services needed for the kids. I would drop them at a heartbeat.
The negative reviews on MetLife dental are accurate. As a dental office, we have dealt with them for years. They seem to be getting worse. A predetermination was recently received. Clearly stating what they would pay for a procedure, the patient paid her share upfront. When the predetermined work was done, the claim submitted, and payment received, it was one half what they had said they would pay. No valid reason. Upon multiple calls to their representatives, the claim is always being "reprocessed". It has been 5 months now. No one can affect any change apparently. Even the supervisors only send it to be "reprocessed" over and over. No change. Obviously the patient does not want to pay either, as MetLife had promised a specified payment amount. Dental office caught in the middle. Union Pacific Railroad - Drop MetLife Dental for the good of your employees.
As you know, they delay until you die. On claim receipt, they do not post receipt for days, adding time, then tell you they have 30 days. Then they SIT, ask dentists to send more x-rays or whatever, SIT, then pay zip. Billing?? NOT even MetLife. It is a GREEDY inept co. named Mercer, IOWA, as part of Marsh financial. THEY are uncaring nitwits that mess up the already INCOMPETENT greedy MetLife morons. NO dental ins pays real cost, YOU DO!!! If your premium is $40 a month, 480 yearly, maximum coverage dollars to YOU annually = 1200, then you paid 480, for 720.00 more!!! What a DEAL, plus headaches and lies!!!
No payment received after performing surgery for their insured. After a year waiting for MetLife dental to pay a claim they denied payment. The reason is because they said that the pt is not longer eligible, and it's true. The problem is that he was at the moment that we perform the surgery, even showing that we have a copy of the breakdown that they send to us by fax. They just don't want to pay and this is not acceptable. We are in network with MetLife and THIS IS THE WAY THAT THEY TREAT US...
I have been fighting for about a year and a half with MetLife because they billed me twice in one month. I still have not received amount of the overpayment. This fight started around June of 15. Despite that, I have been paying my premiums on time. Today I received a letter from MetLife requesting I pay them because they paid my dentist too much. Confused I called to inquire. Calmly they explained that my coverage was cancelled around February of 15. Now I'm really confused and starting to get irritated.
They further explained that the overpayment to my dentist was because of my son's cleaning and I supposedly did not have insurance (and hadn't since then apparently). So with no notice of my supposedly mystery cancellation, MetLife continues to bill me and me being the responsible adult pay my premium. Oh! Let's not forget I was double billed when I didn't have coverage!
So it isn't until I call and inquire to why I owe them, when they owe me, that they realized that they weren't covering me. So I am still left with fighting for the money they owe me and waiting for "their approval to retroactively" give my coverage. Hello people, I never lost it! Very dishonest company and employees are do not know enough to fix a simple problem without sending a request to some department they give a fancy name to make it sound sophisticated. So here I am... waiting with no coverage for my family and me.
I had prophylaxis and some other miscellaneous charges that MetLife picked up, but when it came to fillings they just didn't do squat. I had 3 fillings and an inlay and they only paid 45 bucks. Poor service at nearly $40/month!
My dentist told me I needed 2 crowns. I've spent the last 4 months trying to convince MetLife that yes, they need to cover the procedure that my dentist said I needed done. I can't figure out how a MetLife 'consulting dentist', who is thousands of miles away from me can make an informed decision on what procedure needs to be done. Now it's open enrollment. Goodbye, MetLife dental. You've lost another customer.
I am a billing specialist at a dental office. We are out of network providers but we still file claims for our Metlife patients. We have had so enough dealing with Metlife! It generally takes multiple phone calls, holding hours for their rep, several correspondences for Metlife to take care of one billing problem. Their representatives often give attitude (some of them are very rude), their supervisors aren't capable of making things better (some of them are the same rude). They often lie to us that "everything is all set", however, when we call back to follow up, will just find out NOTHING was done properly. They make billing errors, wrong payments, incorrect processing on a daily base. Terrible overall. We will stop filing for Metlife patients soon.
MetLife agreed to pay for a 40 year old dental bridge which needed to be replaced. When the bridge was removed they discovered the anchor teeth was decayed and needed a crown. This was done last October and I've had to appeal their denial of the bridge because of the additional tooth which needed a crown. I have two MetLife dental policies. I'm angry they are only paying 1/10th of what they agreed to pay. The next open season I will change from MetLife. The work done was over 4 months ago and we're still in limbo.
Back in Dec 2013, my 3 daughters were seen at by a dentist while we were stationed overseas and I paid out of pocket. Upon return to CONUS, I received reimbursement for one of my daughters but the check for the other two kept getting sent overseas despite my calling and correcting the address multiple times. Each time I called, there was a different excuse and sometimes, the check for one daughter was lost or processed in the wrong department. Finally in Dec 2014 (a year later), I asked to speak to a supervisor who promised that I would get the check in January. Yet, I just called today in mid-February and was told that the request only involved one daughter and was again sent to the wrong department. I asked for another supervisor who promised I would get an apology and my checks shortly. I'm not holding my breath!
My MetLife dental insurance ended 8/31/2014. However as of 2/9/15, MetLife has continued to bill my checking account each month. I have contacted them and they have assured me insurance was terminated on 8/31/14. I have made many calls and spent much time on the phone but they have not responded.
Terrible customer service in billing dept. Put on hold for over an hour and no one was able to be reached for a billing matter.
We compared all the payments made by MetLife with our orthodontist's record of payments received. Despite the fact that out EOB said the max had been paid, they were one payment short. I found the mistake. They changed the date they sent payments. On the month of the change, no payment was made. I have called them 5 or 6 times. After going through the complicated process of verifying each and every payment, they saw the mistake. They would then send it to their audit dept who would come back and say there is no mistake. Finally a supervisor saw the mistake, admitted it was a computer glitch and had been happening. My info would go to a claim advocate. Where it has sat for a month. It apparently took two weeks for the supervisor to even send it to this claim advocate. To, me, it's clear this is a game. It's 2014...a computer glitch, really? They make getting to a human in their phone menu, difficult. This seems to be on purpose.
I was told I could have a crown replaced at a certified dental school and then file a claim. I did so and immediately was denied saying they lacked a "treatment plan". The school complied on the same day. I was told to wait 30 days for a decision. Metlife never followed up and again denied my claim when I called them. They now said they didn't have x-rays. The school again complied immediately. I was again told to wait 30 days. When I followed up again, they now said they needed a letter from the dr. explaining the work done and why.
This waiting game continued for 14 months. I again called them only to have them tell me yet again they didn't have the x-rays after verifying earlier that they did have everything. I hired an attorney to send them a demand letter which they ignored completely. The claim was never paid. I was told by the state insurance commission that this company had a propensity to drag out payment to the point a consumer has no more rights to appeal their denial. This company needs to be sanctioned for their dishonest practices.
I had to have a crown on June 17, 2014. I submitted my claim, as my dentist is out of network. My claim was processed and rejected on June 25 because MetLife needed x-rays. My dentist sent x-rays on July 17. My claim was processed and rejected a second time on July 22 and I was informed that it was rejected because the crown was apparently replacing an existing crown.
I spoke with a customer representative on July 22; and, after explaining that I did not have a previous crown, I was told that there was a mistake. The July 22 rejection was based on my original claim without x-rays. On August 8, my claim was processed and rejected a third time. The EOC gave the "Processed Date" as June 25, 2014 and the reason for the rejection was: "Your request has been reviewed by our dental consultants, taking into account additional information submitted. Unfortunately, this information does not offer a sufficient basis for altering our initial decision."
I called MetLife today (August 11, 2014) and I was told that the third rejection was actually processed on August 5, 2014. I was also told that the dental consultants needed a "clinical narrative" from my dentist to prove that I actually needed a crown. I asked why I wasn't told this when I called on July 22 after the second rejection. I was told that it was up to me to know what MetLife needed to process the claim. I suppose that is why the third rejection is so vague. I have now contacted my dentist a second time and he will send the clinical narrative.
About 10 months ago my dentist informed me that I needed a partial crown to repair a tooth with a previous filling that was deteriorating. Because my dentist office, which I have been going to for decades, is not in the MetLife preferred dentist network, I ended up having to put the entire balance due on a credit card (about $1500). I then submitted my claim and did not hear back from MetLife for a couple months. At 1st I figured that it may be taking them longer to review this claim since it was much larger than most of my typical claims for regular cleaning, etc. However, I finally called after a couple months and was told that they were waiting on additional information from my dentists. When I asked if they had contacted the dentist they said no that it wasn't there policy to do so, or something like that and that I needed to contact my dentist to get them to provide additional information.
I then resubmitted my claim and waited about another month. When I called again, I was told that they could not find this 2nd submittal and that I needed to resubmit my claim (if I am recalling correctly). After following through on my 3rd submittal and finding it had been denied, due to there dental experts indicating that they saw no need for the work I was told to have my dentist write a letter. After this was done and I followed up on that I think I was told that they couldn't find the information from the dentist and I needed to have them resubmit.
Eventually it has gone through at least two further reviews, plus one period where I was told that MetLife would re-forward the information to whatever department reviews the claims, but later was told that apparently it had not been forwarded. Currently, now 9 1/2 months later, I called again to check on my claim’s status only to be told that it again has been denied, and that since my dentist is not in their network, when I asked the gentleman on the phone what my options are, I was told that my only recourse at this time is to have my dentist resubmit a claim.
In the mean time I have discovered that, several times when on their automated phone system where I have pressed whatever button I have to have them "mail" me a copy of why my claim was denied, I have never received any thing in the "mail" (even though the automated message specifically says they will) because apparently at one point before all this started I had clicked a box online "to go paperless". And as such it appears that they have assumed that agreeing to go paperless a couple years ago supersedes currently specifically asking for something in the mail. Unfortunately on top of all this, somehow something has gone wrong in their internet site preventing me from accessing my account for the last couple of months limiting me to only being able to try and deal with them over the phone.
I recently retired from the USAF on April 1, 2014 after 24 years of service. I received a billing stating for the month of April 2014. I contacted a Metlife representative and asked if I needed to mail the payment or was it still being withdrawn as a direct debit. She verified that it would be a direct debit and that my family would have coverage until April 31, 2014 for dental care. I scheduled my daughter an oral surgery appointment on 14 April to have her wisdom teeth removed.
When the oral surgeon filed the claim, it was denied. I contacted Metlife on numerous occasions between April-June and management did not return my call until 1 July. Metlife Representative Jaime contacted me just to say, "I'm sorry you were misinformed about your coverage but we will not cover services rendered." My question is how can they charge customers for coverage and not pay; how many other service members are being charged and not provided services?
I have had a number of negative experiences with MetLife Dental, many of them similar to what other reviewers have written. I went through two appeal processes because MetLife would not cover my husband's (very necessary) periodontal work; there was clear network insufficiency (no in-network periodontists within 300 miles) and though we had already met our deductible, we were then subject to an "out of network" deduction and paid nearly the entire periodontist bill. It would be less aggravating and cheaper to have no insurance and I look forward to the renewal date when I will be rid of MetLife forever.
I've worked for several companies in the last 3 decades who've offered dental insurance through MetLife and I've seen their service and their coverage deteriorate to the point that they're virtually worthless. After years of braces, my 22-year-old son was left with straight but, unfortunately, severely damaged gingiva which has required tissue transplants from a periodontist. It took MetLife 10 weeks to even acknowledge that they'd received the statements from the provider (the subscriber ID was missing a digit but MetLife said they couldn't find me even when they were given my social sec #). I complained on their website and finally received a call from their "customer advocate". She did work hard to get things resolved and I received about 23% of the total claim in March 2014...for treatment performed in early December 2013 and early January 2014.
MetLife refused to pay anything for follow-up visits by the periodontist, citing the statement below. Now they're refusing to pay any regular cleaning/preventive maintenance performed by our regular dentist, again citing the statement below. MetLife Dental is the worst excuse for an insurance "provider" by a mile! When I'm done writing this, I plan to call the Sr VP in HR at Siemens Medical Solutions and tell them that MetLife Dental is not a benefit.
I had MetLife insurance through my previous employer. When I left my employer in February of 2014 for a new position with another company, Metlife sent a letter to me and my dentist requesting a refund for services rendered in September of 2013 and stated we only had 45 days from the date of the letter to notify them if there was any discrepancy. Note that the letter was dated over one week earlier than the date I received the letter. When I called, they told me my benefits were terminated by my employer on September 1, 2013. This wasn't true.
Metlife had been accepting premiums from my employer on my behalf up until my termination month of February 2014. When I phoned, they said they had September 1st in the system. They just happened to backdate it to the month I had service. This sounds shady to me. I will be reporting this to IL Attorney General, Consumer Protection Section, The IL Department of Insurance, The Consumer Protection Bureau. I am sure this happens often and needs to stop.
Joined MetLife, mailed $135 check required for Option 2; however, they put me in Option 1. Dentist requested 2 times (in writing, I don't know how many times on the phone) for preapproval on a crown that was supposed to be covered in Option 2. 2 times myself and the dentist received denial notices saying that a crown was NOT covered in my policy. This went on for 3 weeks out of the $135 coverage time period and then dentist received a call (all of this is documented either in writing or recordings) that the crown was covered and they had corrected my Option 2 selection. Because of these delays the crown was installed after that month's coverage and I had canceled. Why pay for another month when MetLife had already made a free $135 off of me?
Now MetLife says that my Option 2 (policy) was NO LONGER IN EFFECT when the crown was put on. Of course not, MetLife wouldn't cover it in the time period requested. Now, does that make any sense. Anyway, since MetLife's rep had spoken directly to the dentist and the crown had finally been approved we set up a time for me to get the required crown. Oh, but that's not all, wait for it... Since the crown was NOT installed in the $135 covered time frame MetLife says that I owe them another $263 because I had canceled my coverage. ALL of this is, like I said, documented by myself and the dental office records and, of course, MetLife if they would only check their records. Would you continue to put out $135 a month after receiving denials? I think NOT.
We have to have MetLife due to bad decisions by someone in the military, now were all stuck with them. I've been fighting with them for an entire year to get my monthly bill fixed. I keep paying them and they keep taking my money, but it doesn't show up on the monthly statements. So I tell them for the millionth time to FIX IT! They send it over to review; they cancel me for not paying because I won't pay them anything if they’re not counting it. They cancel my plan, more back and forth. We supposedly get it all straightened out, the guy swears it's all fixed. He can see it in DEERS that it’s all fixed. I get the next 2 bills.... NOT FIXED! Still not showing credit for all the money I've paid them! I hate them. I hate them!!
I am an Office Manager in a Prosthodontist office in Texas. We are not a Provider office with MetLife. Mind you, a Prosthodontist specializes in tooth replacement via crown/bridge/implants/dentures,etc... I have been in the dental office management field for 24 years. I have been having such a horrific problem this year with getting MetLife to cover implants and all related procedures for our MetLife patients, despite the fact that their plan coverage booklet states clearly that implants are covered. If it's stated that they are not covered, I call the ins. co to get clarification as to the benefits available for the restorations that would be placed on the implant and abutments. We then give the patient an estimate for the treatment and if the patient chooses to proceed, we start their treatment.
We receive, from all appearances automatically, a denial from MetLife due to "not necessary treatment"; then begins the fight to get clearly stated covered benefits actually paid by MetLife. I have to make numerous phone calls, send documents and information that was originally sent with the original claim, and deal with inept MetLife employees that tell me one thing and then tell me another a few days later. This is a nightmare, a quagmire, a black hole that information is repeatedly thrown into and then just disappears. I repeatedly respond to requests for information from MetLife that has been sent to them multiple times and then MetLife claims they never received it. Or one rep will state that it was received and then the next one says that it was not sent through to be considered and processed.
I asked them at what point do I not have to call at each step and do their job for them, to which their response to me was to hang up. I'm so frustrated with them and have started putting THEM on notice that we have noted their repeated, automatic denial of benefits for implants and/or their restorations due to "Not Necessary" and for them to justify, specifically, the denial with valid reasons why they feel that they aren't "necessary" procedures. This is so unfair for the patients that are paying their premiums and cannot receive their clearly stated benefits due to MetLife's unspoken policy to deny any claim that they think they have a shot at no one responding to, thus saving themselves the cost of the payment on those denied claims.
The truth of the matter is, the bean counters at MetLife know that only a certain percentage of denied claims will be appealed and that of those, even fewer will be appealed again, thus saving the company literally, Millions of dollars. Shame on MetLife for pulling this stunt on their subscribers. The poor patients then have to pay for the full fees charged, and think that we, the treatment coordinators and office managers, don't know what we are doing or are trying to hide something from them in order to have them start their treatment. Nice ploy, MetLife; it takes the heat off of you and re-directs it to the ones that are trying to HELP your subscribers and families, unlike you!
A cautionary tale about a root canal gone wrong and the time suck of dealing with MetLife dental insurance. My warning: get a second or third opinion for any dental or medical procedure! And make the dentist be very specific and clear how much it will cost. Because if there's any question as to the medical necessity of the procedure, MetLife will make your life hell when you're trying to get your money back!
The story of tooth number 19: In 2005, I had a molar (#19) with cavities that my dentist (Dr. **) at the time in SF thought were too deep for him to fix. So he referred me to an endodontist (Dr. **) to get an evaluation. I went to ** and immediately he told me that I needed a root canal and said he can do it right now. So we did it. It turned out to be the biggest dental mistake of my life. Eight years and $3,000 out of pocket later, I'm just finishing fighting to get paid for all the procedures I needed as a result of that little trip to the dentist. Here's what happened: the first root canal caused my mouth to hurt for the first time. Until then, there was no pain. This should have been enough indication for me not to have anything radical done, but mistakes were made. So ** re-did the root canal two more times! And it still hurts. A couple years later, it's confirmed that the tooth was cracked, probably due to the multiple root canals, and needs to be removed.
My advice is to get two or three opinions before you do any non-emergency dental or medical procedure. Other dentists, including my dad in NH, said I should have just let the tooth be until it started causing a problem or pain. My current dentist (**) said he would've just put a crown on it to preserve it for as long as possible. Yet another dentist (Dr. **, SF) said that it is also necessary to get a pulp test done to fully evaluate the tooth before getting a root canal. You live and you learn, the hard way. So, starting November 2010, I got the tooth pulled and readied for an implanted crown. For at total of $5,700 later, I have a nice, new fake tooth that works very well. Thank you very much.
But now starts the part where I begin a near endless battle with MetLife to get various parts of the procedures paid for, such as a bone graft and general anesthesia. I eventually got paid back for about $1,000 for these things but in many ways, I earned that money because I had to put in about a hundred hours to get it done. That's the state of MetLife's claim payment process these days. At first, I tried dealing with them over the phone but that led from one wild goose chase to another. So then, I complained on their Facebook page and began emailing with a responsive MetLife employee. Progress was made but a very slow pace. My advice again is to go price shopping before you get dental work done. Ask how much for every little bit of it. Ask how much insurance might pay for. Ask if there are items that insurance might not pay if you can avoid them, and then avoid them. This will help reduce your costs and your pain of dealing with insurance companies.
Some suggest that MetLife makes it so difficult to communicate with them as a way to discourage customers from getting paid for dental work that MetLife should pay for. I must say that the dentists are part to blame for MetLife's cheap ways. MetLife makes dentists prove that certain procedures are medical necessary before they will pay for them. (The problem with MetLife is that even after providing that evidence, it may get lost or buried, and it will take you another dozen phone calls or emails to get paid.) The oral surgeon that did the extraction and implant (Dr. **) probably push the limit on the definition of medically necessary. Did I really need general anesthesia for the extraction? I probably didn't need a so-called healing cap on the implant post because that should have been part of the post included in the price in the first place!
So, proceed very cautiously before getting a root canal or any other dental procedure (other than cleaning) because otherwise, you might be in for a lot of time in a dentist chair and on the phone or online with an insurance company. Some of the details of dealing with MetLife 2010-2013: MetLife has made it very difficult for my dentist (Dr. **) and I to get claims paid for covered dental procedures. We've been trying for 3 and a half years to get these matters resolved. In January 2013, MetLife stopped paying for any of my family's standard dental benefits (such as cleanings) because of a mistake that MetLife made. They paid for two abutments when they should have only paid for one. MetLife forced my family to get my other dentist (Dr. **) to return the payment to them.
Since then, I have personally pursued payment of my claims. I have made dozens of phone calls and written many emails. MetLife does not seem to be very well organized. You talk to one employee and they tell you one thing, and then talk to another and get another story. It also seems like they misplace documents, such as the letter written in 2010 by Dr. ** explaining why I need the general anesthesia. One MetLife person told me that the appeal to have the general anesthesia covered (which was prompted by my dentist's letter) had been denied. The next time I called, I was told by another MetLife person that the letter had never been received and that I should resend it, which I did.
I finally spoke to a supervisor (Melisha) at their call center who said she would expedite my general anesthesia claim when she became ill and could not work for two weeks. After 3 weeks, no progress had been made. MetLife should have other people cover for sick employees, especially for expedited claims. In April 2013, I complained about all this on MetLife's Facebook page and soon after got an email response from Susan **. It was much more effective for me to pursue my claims this way, though it still required a lot of effort. For example, after considerable effort to get MetLife to pay for general anesthesia for the extraction procedure, I was told that I would be reimbursed $303, even though I was charged $364. MetLife's explanation was that back in 2010 when the procedure took place, the maximum claim paid for general anesthesia was $303, and that's all they would pay. But I pointed out to Susan that my statement of 2010 showed that I paid $364. Susan took another look at it and concluded that $364 was the correct amount.
Initially, when MetLife agreed to pay the $303, they said it was going to send the check to Dr. **. Once it was determined I was going to get $364, I emailed Susan and asked her why the money was going to be sent to Dr. ** when it should be sent to me. She acknowledged the mistake and said that after canceling payment on the first check (that never actually got sent) MetLife would send the check directly to me as of today, Monday May 20, 2013. Communicating by email with MetLife is much more effective in that I get to correspond continuously with the same person. However, the process of getting fully reimbursed for certain procedures is still very time consuming and difficult.
I also went through a similar amount of time and work to get paid for a bone graft that was done at the time of the tooth extraction (11/19/10). I finally managed to get MetLife to pay for the bone graft (after getting documentation of the periodontal gap that necessitates the bone graft). I got paid $643.40, even though I paid $695. The reason for the short change is probably the same as for why I was initially shorted for the general anesthesia (MetLife would probably say that is how much they paid for that procedure back in 2010). I could pursue this $61 but I won't because I am too exhausted by the whole affair. Every time I log onto MetLife, I am asked to go paperless in terms of the statements I receive. I continue to refuse to do this because I find it difficult and time consuming to access the relevant info on the MetLife website and to decipher and find the information I need.
It was a surprise for me to learn that MetLife often only covers half the cost of big ticket approved dental procedures. It looks like that for dental work items over $1,000 (such as an implant or a crown), MetLife covers at 50%. But for items smaller than $1,000, it often covers 100%. The point is that it is important for someone considering expensive dental procedures to have a very accurate idea of what and how much each item is covered. Otherwise, there can be some very expensive surprises. I acknowledge that some of the extra steps that MetLife requires in order for certain claims to be made are done in attempt to minimize the number of unnecessary procedures. And I think that is a good thing. In fact, it is possible that the items that were most difficult for me to be reimbursed for were borderline unnecessary, such as the general anesthesia for the extraction, the bone graft and the two abutments.
But there needs to be a more streamlined process developed to have such borderline procedures evaluated. (And, of course, dentists need to let patients know that some of the procedures may or may not be covered, and then given the option to forgo the item in order to avoid the uncovered cost). However, this does not excuse the inefficiencies I encountered while trying to communicate with MetLife. In retrospect, I might not have had Dr. ** give me general anesthesia during the extraction had I known that it might not be covered. The same applies to the so-called healing cap abutment that he gave me. This is not true of the bone graft that was done (which took a lot of effort to get covered) because Dr. ** told me that I needed it to better guarantee a good result with the implant. Assuming I get the check for the $365 as mentioned above, the total out of pocket cost for the extraction, implant and crown for tooth number 19 is $2,294.70. MetLife paid $3,395.80 for a total of $5,751.50. For one tooth! It's a whole other story but tooth number 19 should not have needed to be replaced in the first place!
Recommendations for dental patients: Make sure your dentist very clearly and carefully specifies how much procedures cost beforehand, then ask which of those have any chance of not being covered and to what extent. If there's a chance something will not be covered, try to avoid having it done. The root canal that went wrong in 2005. In 2005, my dentist at the time (Dr. **) referred me to a root canal specialist (Dr. ** in SF) to evaluate a deep cavity I had in tooth #19. Dr. ** said the tooth needed a root canal and he did it on the spot. Insurance covered the root canal but not the crown. Out of pocket cost was $500. As a result, it is likely that this root canal (and the two others it took to try to get it right) contributed to the distal (rear) root of the tooth to crack and allow bacteria to reach the bone and cause bone loss. The tooth needed to be extracted.
Since then, two other dentists have told me, given that prior to the root canal the tooth was not causing me any discomfort, that I should have instead just monitored the tooth or had a crown put on top of the tooth. I have also been told that a pulp test should be done prior to a root canal. Make sure your dentist does whatever he can to preserve a tooth, get a root canal only as a last resort, and get a second or even a third opinion before doing a root canal.
MetLife Billing Problems Company Information
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