My question involves dental insurance coverage and pre-authorization.?

For example. Say I have coverage through my employer. I go to a dentist for a root canal and ask whether or not my insurance is accepted. I am then told that it is accepted. The work is performed and later I receive a bill for services. I contact the dentist who says there was a problem with your insurance. So I guess my question is, what obligation does the provider have to verify coverage? Is there any recourse after one has relied on a representation that a cetain procedure was covered and it is later discovered that it was not?
--------------------
Unfortunately it is always the responsibility of the patient to be aware of their dental coverage. It should be outlined in the patient's handbook. The provider only has contracting discounts that the are obligated to take. But if a service is not covered there is not obligation to the provider. Even when a service is pre authorized it states that it is only an estimate and is never a guaranty of coverage. Remember there is a difference between "accepting" and insurance plan and coverage verification. Individual services are usually covered at a percent that is set by the employer. A patient is still liable for a difference in the insurance's usual and customary fee and the provider's fee, plus any deductible remaining, in addition to that percent set by the employer. It is possible for a patient to be liable between 30 - 50% of the actual cost of a root canal with an accepted insurance. I manage an endodontic practice, here I always tell them that we accept most insurances though we are only in network and contracted with a few. Even though we accept most insurances this only mean we will accept any payment they make. But say the insurance doesn't respond, We bill the patient. We also state the we only file claims to insurances as a courtesy but again we are not obligated to. I hope this info helps.
Source