The subscriber/member indicated she believed her provider was short paid on her claims for cleanings and a crown with dates of service in October Our records for provider network affiliations, which are maintained by a third party, inaccurately indicated her provider at the treating dental office location was in-network and her provider was paid correctly based on that informationHowever, upon notification of this complaint, we investigated with that third party the nature of this provider's network affiliation and it was determined this provider is out-of-networkAs a result, we reprocessed the subscriber's claims today, 1/19/2016, for both dates of service in question providing the proper additional payment of $(a total now of $333.77) for her October 1st date of service as well as an additional $(a total of now $718.36) for her October 29th date of service including the crown procedure indicatedBoth payments were mailed today to her provider which will result in a payment to her to reimburse her for Cypress' portion of the procedures she previously paid up front in full to her provider
The subscriber/member indicated she believed her provider was short paid on her claims for cleanings and a crown with dates of service in October Our records for provider network affiliations, which are maintained by a third party, inaccurately indicated her provider at the treating dental office location was in-network and her provider was paid correctly based on that informationHowever, upon notification of this complaint, we investigated with that third party the nature of this provider's network affiliation and it was determined this provider is out-of-networkAs a result, we reprocessed the subscriber's claims today, 1/19/2016, for both dates of service in question providing the proper additional payment of $(a total now of $333.77) for her October 1st date of service as well as an additional $(a total of now $718.36) for her October 29th date of service including the crown procedure indicatedBoth payments were mailed today to her provider which will result in a payment to her to reimburse her for Cypress' portion of the procedures she previously paid up front in full to her provider