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tryandfindus | Question about insurance covering dental procedures? Please answer!!? |
My insurance covered my orthodontics as a teen.
They covered all routine dental work.
They covered a procedure in which I had a baby tooth pulled, because there was no adult tooth underneath.
They paid for the retainer that I had to wear in order to prepare my mouth for the eventual 'fake tooth' that would be installed in the 'hole'.
They now say that they will not pay for the procedure in which the fake tooth will actually *be* installed, nor for any related lab tests and referrals, calling it a 'cosmetic procedure'.
What the h*ll!!
If this is cosmetic, then what, exactly is orthodontics defined as?
And how about the pulling of the tooth in the first place?
Why will they not pay for the final result?
(any answer appreciated, since I now have a big hole in my mouth, and can't afford the several-thousand dollars to fix this!) |
 |
 
Len S
 |
You need to see which of these plans you have taken There are two options while taking a dental insurance:
Open panel: You have the right to choose a dentist of your own liking. The dentist can refuse to treat the patient.
Closed panel: Under this option you can choose only the dentist who is under the contract with the insurance company. You can only choose the dentist who has a contract with the insurance company.
There are 3 types of dental insurance plans, indemnity plans, capitation plans and direct reimbursement plans. |
|
Suzanne: YPA
 |
Check the "Exclusions" portion of the policy; most dental policies won't cover dental implants, regardless of the reason the implant is needed (i.e. cosmetic OR medically necessary). If this service is listed as an exclusion, there's little you can do, even if it's medically necessary (which it is in your case, because you will suffer bone loss if you don't put a replacement tooth there; you may also suffer misalignment of the teeth, but that would be cosmetic).
If you need further assistance, contact your state's insurance commissioner's office. |
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Serge M
|
Read your insurance policy. The company will pay for procedures that are covered, but most policies do not pay for cosmetic work. Sometimes it is a matter of interpretation whether some procedure is cosmetic or medically required.
Your orthodontist should be able to interpret your policy. If the amount of money involved is not large, it is probably best for you to pay it. But if it is a significant amount and you don't agree with the interpretations, you may want to have a lawyer look at the policy and try to arrange for payment by the insurance company. |
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Custo
 |
dental implants aren't covered.
You're luck all the pre-work was covered.
Get financed through the dental office if you can. Start a payment plan. Good luck. |
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Lulu
|
Sounds like you had an orthodontia benefit which is how you got all the orthodontic work paid for. Get a copy of your benefits and read that section. It probably says something like, straightening and removal of the teeth is covered. It won't say anything about adding fake teeth because this is considered a dental implant. Elsewhere in the policy it will say dental implants are not covered. |
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Jifr
|
ok...well....
Health insurance does not cover dental procedures. Period.
DENTAL insurance does and it usually is VERY very restricted.
In my experience, a fake tooth would be considered cosmetic. If you do not already have a copy of your policy - get and read what they define as cosmetic.
I'm not sure that they "paid" for all those prior procedures but you may have a cause for an appeal if they did. The process for filing an appeal should be in the policy as well.
Good luck.
~jifr! |
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