After the dentist extracted all her teeth, Mary had to wait for her new dentures. She was excited to learn they were ready, but when she arrived at her dentist’s office, the staff said she couldn’t have them. Unless she paid out of pocket. The price was $2,600.
Mary was devastated. She’d been dropped by her dental insurance, the office explained.
Mary called Lone Star Legal Aid for help. Attorney Susan Schoppa took the case. Ms. Schoppa knew Humana wouldn’t drop her without prior notice. Health insurance plans typically renew automatically – unless a person chooses another plan during open enrollment in the Fall, which Mary hadn’t done.
In the process of reviewing Mary’s application for legal assistance, Ms. Schoppa met Mary’s sister. The sister explained that Mary had a kidney disease. She suffered from forgetfulness, a common complication of kidney disease. Instead of asking Mary to call the insurance company herself, Schoppa decided they’d make the call together. She asked Mary for the phone number on the back of her insurance card.
After talking to several people, Schoppa understood that Mary had not been dropped. Humana had transitioned Mary from one type of plan to another. The old plan covered dentures. The new plan did not.
Undeterred, Ms. Shoppa continued to look for a solution. She pulled the prior plan and double-checked the coverage.The dentures were covered. The dentist removed Mary’s teeth and ordered her dentures under the old plan. Ms. Shoppa wondered if it was possible for the dentist to bill for the dentures under the old plan.
Ms. Shoppa spoke to Mary and her sister. She asked them to call the billing department at the dentist’s office. Could the office manager find the date when they first started working on Mary’s teeth? Could they bill the old plan using that date? The sisters spoke to someone at the dentists’ office. The office manager agreed to try it.
Within a month of contacting Lone Star Legal Aid, Mary was able to pick up her new dentures. They were approved under the prior plan, thanks to LSLA’s Susan Shoppa’s efforts.
*Names have been changed to protect the identity of the client.
Lone Star Legal Aid (LSLA) is a 501(c)(3) nonprofit law firm focused on advocacy for low-income populations by providing free legal education, advice, and representation. LSLA serves millions of people at 125% of federal poverty guidelines, who live in 72 counties in the eastern and Gulf Coast regions of Texas, and 4 counties in Southwest Arkansas. To learn more about Lone Star Legal Aid, visit our website at www.LoneStarLegal.org.
Media contact: media@lonestarlegal.org