I live in North Carolina, and I had to go out of network to receive TMJ treatment. There was not a single in network provider within a 50 mile radius of me, and this was the only provider that billed to medical and not to dental (my medical covers TMJ, my dental does not). I called Cigna IAA prior to visiting this doctor, and was told that the services I was requesting would be covered at 80%. I emphasized this several times and they confirmed that I would be responsible for 20% of the cost, and insurance 80%. I finally got my claim back for a $600 visit, their allowable amount was only $400 and some change, and I got 80% of that number. I have already put a 2.5k payment on an appliance, and have to give the remaining 2k balance at my next visit. Of course now I know about the “allowable amount” but they neglected that information prior, and now I might be out $5k. I’m really freaking out and I need to know if there’s anything I can do. I called IAA and they instructed me to call the company that decides their allowable amount, but I have left voicemails and emails with no luck. What should I do? Is there anything I can?
Posted by schellybeans