Hi, good afternoon.
Thank you for calling Humana Dental.
My name is K, may I know who am I speaking with?
Yeah, hi, this is Johnny Doe.
Oh, hi, good afternoon, Miss Doe.
How can I help you?
Hi.
Um I was just uh uh I want wanted to ask a question here.
I've got uh a summary, a claim summary about my dental and it says that they uh the amount not paid by humana was $45 and they will bill XXX.
And then I was just wondering the $64 why it wasn't covered?
It says per ok.
Sure ma'am.
Oh, go ahead.
I'm sorry, I'm sorry.
Well, that's ok.
It just says I had a, it said benefits for this service had been satisfied and the frequency limitation has been exceeded.
Sure ma'am.
I can definitely check that here.
What was the date of service?
Uh, it was um, let me see here.
Um uh July June Xth.
June 6th?
Ok, let's take a look here.
Ok, so yes, I do see that it's for a cleaning bite wing peria and oral evaluation.
You might have paid $XXX.80 and it shows that.
The periapical .com has been denied since based on your plan you're covered for one periapical .com a year and based on your tooth history, let me check here.
You've got this procedure on
Well, I had one, yeah, I had one xray done on one tooth because that was the one that was um pulled.
April.
So they, they, they did an xray on that one tooth before I, before they pulled it and then I went back for cleaning and then I went for a full set of X rays.
But they, is that, so you're only allowed, I only had one xray done on one tooth the first time.
Is that why it's denied
yes, you're only covered for one periapical .com a year since you've got the same procedure on April.
It will be end up as a responsibility for the second one.
But have you ever received a bill from the dental office?
I haven't gotten anything yet.
Uh, uh, I'm waiting for, uh, they're waiting for an approval on, they put in a, um, I have to, I have to have some other work done so they, I guess they, they're sending, they're sending to, to see what's covered,
Yes, ma'am.
Yes, absolutely.
you know.
So the letter that you received ma'am is not a bill.
It's just an explanation of benefits.
It means that you, if you haven't received any bill from the dentist, that means you don't have to pay anything.
But I'm not really sure if you're already aware of this, but you have a flex benefits.
Are you aware?
Yeah, I have that card.
I have the card.
It's got $200 on it, right?
Uh, XXX.
XXX.
No, I just got the statement and I know, um, I mean, if I have to pay it, that's ok too.
I understand, you know, I mean, I just was wondering because I, this is the first time I've gone to the dentist and uh
I agree.
you know, and uh do you have anything showing where they're waiting on a uh a claim or coverage?
No, ma'am.
Uh, we only have three claims and it has been paid already.
April XX.
Uh May X and June Xth.
Yeah, because I don't know when they um, I don't know when they submitted it but they told me I, that I, I needed some additional work done and they said they were gonna submit it to see what was covered before I had the work done.
I is it like a preauthorized about your future procedure ma'am?
Right.
For that one, we haven't received anything yet.
Uh we only received an actual claim, ma'am, so I.
Oh, ok.
Well,
like I said, I don't know when they submitted it, you know,
Yes, but I would.
and then they were gonna call me.
Absolutely, ma'am.
Uh yeah, I would like to inform you ma'am that as of this date you still have uh $4685 left from your dental and XXX to your flex benefits.
That will be.
Expire on the end of the year.
Uh-huh.
All right.
Thank you.
I'll just wait because I, I know I'll be going back to them, you know,
and, uh, you know, see if they, I get a bill from them or what.
So, I'm, like I said, I'm just waiting for this other, uh, procedure that I need to have done and they were gonna,
uh, send it in to submit it to him to see if what was covered or not before I had the work done.
Yes.
So.
Absolutely ma'am.
What would you want me to call them to ask an update about the estimation or do you want me just to wait until they send it?
Ok, I, I, it's, I don't know, it's up to you.
I don't, I don't uh you know, if you wanna wait, I because it's, it's up to you, I'm sure they submitted it.
Ok.
So I guess it maybe it takes a while before uh
you will get it, I guess.
Or
Yeah.
But did they inform you, what was that for?
no, I have no, it's a, I have a loose tooth and he told me that uh he was worried about the tooth falling out
Is it for a crown or something?
and he mentioned that he was going to put a wire to hold the tooth in place so it doesn't move and there and I said I'd like to have that done.
So I don't.