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'That's wrong': Dental insurance mix-up costs Chicago woman $11,000

'That's wrong': Dental insurance mix-up costs Chicago woman $11,000
'That's wrong': Dental insurance mix-up costs Chicago woman $11,000 02:35

CHICAGO (CBS) -- A Chicago woman's new set of teeth should have left her smiling, instead, she's mouthing off to the Morning Insiders about an $11,000 bill she feels she's owed from her dentist's office.

CBS 2's Lauren Victory explained the insurance mix-up.

"I expect to live another 30 years, so for those 30 years, I'd like to have a more magnificent smile, see?" said Sheila Tucker.

Tucker is very proud of her teeth, despite all the x-rays, exams, and 11 replacements needed.

"I was willing to go the extra mile to get a nice white, bright smile," Tucker said.

That extra mile meant handing over $11,000 upfront to Dental Dream Team on 87th Street. They granted her wish for new pearly whites in August 2021 and sent in a dental insurance claim on her behalf.

Six months went by with no reimbursement check, so she inquired with her provider.

"They had no claim!" Tucker said. "Then I had to do a deep drive with my dentist to find out why don't they have a claim."

It turned out Tucker's paperwork was sent to Humana. That's not her insurance provider and never has been.

"'What the heck happened?'" Tucker said. "That's what came out of my mouth. 'What the heck happened?'"

A closer look at the incorrectly submitted claim shows even more mistakes. Tucker was not born in 1963 and the Texas address listed is nearly 900 miles away from her home in Chicago.

"Actually, I've never been to Texas so that's wrong," Tucker said.

Then her new claim to the correct insurance company, Ameritas, was denied. "Plan pays zero" because of "time limit issues."

The Ameritas website shows claims must be submitted "within 90 days" of service, not several months later.

"Ameritas should have some compassion and understand that that was not my fault," Tucker said.

So how did the insurance mix-up happen? CBS 2 took our questions to the dentist.

She said off-camera that her staff sent the initial claim to the address in Tucker's file. 

Why was it the wrong insurance information?

The dentist doesn't know but said they did everything they could to help tucker fight for reimbursement, including filing an appeal on her behalf.

That appeal was also denied.

Ameritas took a third look at Tucker's case, when CBS 2 got involved.

The insurance company wound up waiving its time limit requirement after buttoning up a few more details with the dentist's office.

Now, Tucker is back to smiling, because she said she's been promised a $1,500 check from Ameritas.

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