Question roughly speaking 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 have a baby tooth pulled, because there be no adult tooth underneath.
They paid for the retainer that I have to wear in order to prepare my mouth for the eventual 'fake tooth' that would be installed contained by the 'hole'.
They now say that they will not earnings for the procedure in which the fake tooth will truly *be* installed, nor for any related lab tests and referral, 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 within the first place?
Why will they not pay for the final result?
(any answer appreciated, since I now enjoy a big hole in my mouth, and can't afford the several-thousand dollars to fix this!)
Answers:
dental implant aren't covered.
You're luck all the pre-work was covered.
Get financed through the dental bureau if you can. Start a payment plan. Good luck.
Check the "Exclusions" portion of the policy; most dental policies won't cover dental implants, regardless of the reason the insert 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 within 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 requirement further assistance, contact your state's insurance commissioner's office.
You need to see which of these plans you enjoy taken There are two options while taking a dental insurance:
Open panel: You have the right to choose a dentist of your own keenness. The dentist can refuse to treat the patient.
Closed panel: Under this risk you can choose only the dentist who is under the contract near the insurance company. You can only choose the dentist who has a contract next to the insurance company.
There are 3 types of dental insurance plans, indemnity plans, capitation plans and direct reimbursement plans. Source(s): http://dental-insurance-tips.info/
Read your insurance policy. The company will pay for procedures that are covered, but most policies do not recompense 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 hulking, 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 hold a lawyer look at the policy and try to arrange for payment by the insurance company.
ok...well....
Health insurance does not cover dental procedures. Period.
DENTAL insurance does and it usually is VERY terribly restricted.
In my experience, a fake tooth would be considered cosmetic. If you do not already have a copy of your policy - carry and read what they define as cosmetic.
I'm not sure that they "paid" for all those prior procedures but you may enjoy a cause for an appeal if they did. The process for filing an appeal should be contained by the policy as well.
Good luck.
~jifr! Source(s): insurance professional 10+ years
Sounds like you have an orthodontia benefit which is how you got all the orthodontic work remunerated for. Get a copy of your benefits and read that section. It probably says something resembling, straightening and removal of the teeth is covered. It won't say anything about tallying fake teeth because this is considered a dental implant. Elsewhere surrounded by the policy it will say dental implants are not covered.
Related Questions:
They covered all routine dental work.
They covered a procedure in which I have a baby tooth pulled, because there be no adult tooth underneath.
They paid for the retainer that I have to wear in order to prepare my mouth for the eventual 'fake tooth' that would be installed contained by the 'hole'.
They now say that they will not earnings for the procedure in which the fake tooth will truly *be* installed, nor for any related lab tests and referral, 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 within the first place?
Why will they not pay for the final result?
(any answer appreciated, since I now enjoy a big hole in my mouth, and can't afford the several-thousand dollars to fix this!)
Answers:
dental implant aren't covered.
You're luck all the pre-work was covered.
Get financed through the dental bureau if you can. Start a payment plan. Good luck.
Check the "Exclusions" portion of the policy; most dental policies won't cover dental implants, regardless of the reason the insert 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 within 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 requirement further assistance, contact your state's insurance commissioner's office.
You need to see which of these plans you enjoy taken There are two options while taking a dental insurance:
Open panel: You have the right to choose a dentist of your own keenness. The dentist can refuse to treat the patient.
Closed panel: Under this risk you can choose only the dentist who is under the contract near the insurance company. You can only choose the dentist who has a contract next to the insurance company.
There are 3 types of dental insurance plans, indemnity plans, capitation plans and direct reimbursement plans. Source(s): http://dental-insurance-tips.info/
Read your insurance policy. The company will pay for procedures that are covered, but most policies do not recompense 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 hulking, 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 hold a lawyer look at the policy and try to arrange for payment by the insurance company.
ok...well....
Health insurance does not cover dental procedures. Period.
DENTAL insurance does and it usually is VERY terribly restricted.
In my experience, a fake tooth would be considered cosmetic. If you do not already have a copy of your policy - carry and read what they define as cosmetic.
I'm not sure that they "paid" for all those prior procedures but you may enjoy a cause for an appeal if they did. The process for filing an appeal should be contained by the policy as well.
Good luck.
~jifr! Source(s): insurance professional 10+ years
Sounds like you have an orthodontia benefit which is how you got all the orthodontic work remunerated for. Get a copy of your benefits and read that section. It probably says something resembling, straightening and removal of the teeth is covered. It won't say anything about tallying fake teeth because this is considered a dental implant. Elsewhere surrounded by the policy it will say dental implants are not covered.
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