Wednesday 15th of November 2017 09:22:53 PM
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!