| Home | About Us | Benefit Check Up | Story Bank | Find Your BenSpec | Contact Us |
Jennifer helped a client get a dental bill issue resolved. The client has a Medicare Advantage (MA) plan with some dental coverage. She went to a dentist for some covered dental work and was told she would have no co-pay for the services. At the appointment, however, she was told she would have a $400 co-pay. Then, she received another bill for $800. Jennifer helped this client connect with her MA plan who helped advocate for the client with the dentist. The MA plan opened up a fraud case against the dental provider who promptly returned all payments to the client.
Monetary Impact = $1,200
6/29/2023
Story #84
Terri Esselman, EBS of Clark County, helped a client obtain Prior Authorization from Medicaid for partial dentures. The client's original dentist received the necessary prior authorization, but due to a series of staffing changes at her provider, the client was not made aware of the approval nor was the procedure scheduled. The prior authorization then lapsed (it was only effective for one year), and under the new dentist it was now being denied. The client came to Terri for help. It took months to get the provider and dentist to provide necessary records. Ultimately, the client requested a Fair Hearing. Terri's BSSA submitted a summary brief and a form signed by the new dentist, and Medicaid agreed to issue a new prior authorization without the need for a hearing. This client was having difficulty eating, had lost a significant amount of weight, and had stopped leaving the house due to her self-consciousness of her missing teeth. Terri's advocacy will make a tremendous difference in her life.
5/31/2023
Story #79