Damn I am Pissed... My Dental Ins denied my claim!

I had a crown fall out...one of my front lower. Also, my dentist did some work to block an opening between two crowns that could get food caught between them. Met Life(my primary) sent me a denial of both claims because they determined they were both "cosmetic".

I can only hope that my wife's coverage will now accept to pay more than they should have....How do you think they will feel about that?

Damn! Each procedure cost $795.00, money that I don't have that is for sure.

COSMETIC!!! I guess having teeth missing is more accepted in the business world than I thought!

:wtf:

The candidate that puts health care first on their list has my vote!

Been there, done that. Ended up paying myself.

I think any dentist would tell you that fitting a crown is a necessary dental procedure and not cosmetic. I would appeal.

I have dental issues myself. I have some trouble with my jaw that is probably related to TMJ issues. My insurance company has a clause that specifically excludes all TMJ-related problems. I have a separate dental plan that is basically a dental discount plan. Which mean any TMJ treatment (excluding surgery- which WOULD actually be covered by my medical insurance) is going to cost a lot. So I just take some Aleve and hope it stops aching. I gather that there isn't much that actually works for these problems so maybe it is just as well.

One can take a mild muscle relaxant to stop the spasms if they are that painful.

If the crown fell out, make sure your dentist states this in a letter that you can send along with a request for consideration from them. Keep after them as what you are talking about is not cosmetic by any means and they know it. When was the original work done and when did it have to be redone.

You have to fight them which unfortunately is a problem with our health care until someone gets in office that puts a stop to this sort of crap.

Good luck on it but crowns are expensive, so don't let them just ease out of this as they are hoping.

cc: your reps on it too including Michael.

detailed explanation of what and why she did what she did...

I feel a little better now after talking to the claims person for my dentist.

Thanks for the advice...

anything?

it's almost like ...what's the point (???!!!)
I'd rather negotiate a better rate with my dentist and give him cash.

good dental work at a faction of the cost in the US

in their plan,or a dentist not in their plan?

Just curious ! My dentist is not in Met Life's network so they don't cover much.

Good luck!

my dentist does not participate -- so i have the same problem. however my oral surgeon participates which is a blessing because i've had several implants.

of course, they don't pay the whole amount. i believe they allow them to be replaced every 5 years.

my husband has periodontal problems and gets a deep root scaling every 3 months. the plan only allows for 2 and again, they don't pay the whole thing. sometimes i look at the premiums we're paying and wonder if it's worth it.

they also only pay a maximum of $2,000 per year.

copay is $575! He had to get 3 last year!!!!!!!! I honestly wonder how much the damn crwns are if you don't have any insurance?

I needed to replace my upper plate 2 year ago and the copay was gong to be $3,000! WHAT THE HELL???? Where's the damn benefit?

i purposely waited till january because i was maxed out for the prior year. the total was 5775.00. met life paid $1196.00 my share was $4579.00. then i got another implant in june. that maxed out my coverage for the year. and of course, i had several cleanings and x-rays and a filling that i paid out of my pocket.

I sure can't! I had to pay for my hubbys crowns over 6 months! Our total annual income is $29,000, and I never looked at that as being poor, but I sure don't have any spare thousands hanging around either!

we have a good income, but i've never forgotten all the years we struggled to make ends meet.

i just paid him $2,000 for an implant crown, which has gone up since last year. i believe the insurance will pick up around $650.

Metife leaves a lot to be desiredl - and I participate in the plan.

Not surprised...I had a case wherein the lady was going to be getting radiation therapy and so I did much routine work in one visit. they requested films and so I sent them. Time went by and I called them and they claimed they never received the films...in this case, my only copy. I wrote them a letter, and they denied the claim in toto. Tough shit to me, right.

I ate the fee, since this woman in no way shape or form could afford the work whcih I did at this stage of her life.

This happens a lot...you can appeal...good luck.

to eat the fee. not all dentists are that understanding.

funny screen name in a dental thread..

Sorry.

Many of us are humanitarian - we are often pilloried, HERE, among other places for being money-grubbing. Well, so's McDonald's if you try to walk out without paying.

That being said, no one has ever left my office in pain b/c they couldn't afford to be taken out of pain. If the tooth has to go, b/c root canal is un-affordable, it's a shame but not fatal. Pain and infection can be (N.B., I don't do Root canal in my office - I refer.) and I'll prescribe antibiotics and/or extract rather than have someone get sick or die. It can happen even in the 21st Century.

i'm actually very careful about that.

There are so many not-worth-the-effort dental plans out there. Until I needed my first crown the plans always made money off of me, and the payment amounts for crowns and root canals is so paltry that they're barely losing any money even in two years that I've needed work.

There doesn't seem to be any movement towards recognizing that many dental procedures are necessary for overall health and well being either.

I think that payors should be responsible for this medical/dental stuff in toto. I wouldn't mind at all. Right now, it's a frigging nightmare on elm Street every frigging day, economically.

That's what annoys me as a consumer --- I shouldn't have to guess whether the work is covered or not. Tell me what's covered and pay up, period.

but helping people is what I do. No matter what the cost. It's what we're supposed to do.

I ask this as a "dentally challenged" who seems to pay full price where those with insurance get breaks I don't. :shrug:

Mine is a totally separate plan. I do not pay very much for it but I don't get much either. So far that has not been a problem, as two cleanings a year is not that expensive. But if I ever have serious problems, it will not cover much.

Even the one my son has through a very large prominent employer is the same. I've considered calling my husbands employer and telling them they should save their money! I'm sure it costs the company quite a bit and the benefits are minimal at best!

some ins. is really wonderful as far as I'm concerned...it's brought great dental health to millions and millions. As you can imagine I have a real eclectic practice and treat mostly working class people. have one of the largest ongoing practices in my areal of Philly and am known as the creative dentist of last resort. I've helped many people thru every type of problem imaginable and have even set up strangers who've gottne married on a few occasions.

Access to routine care for many has only been since the advent of insurance, including but not limited to city employees, major companies's personnel, and association members, i.e. groups which formed to purchase good policies.

It just depends upon what the employer is willing to spend and for the employees to accept the fact that their salaries will be less, but the opportunities for better dental (and thus medical health) are greater.

As a "denally challenged" it covered "one crown." That was the problem. When we got downsized we checked out private Dental Insurance...and the most we could get was $1,000 per crown and the coverage cost us three times as much...so we didn't get it because we felt the $1,000 per crown in case our crowns failed or teeth failed needing crowns...better to try to cough up the money than pay three times the cost per year for the insurance.

I know lots of Dentists are offering Plans with Credit Cards to help folks...but still...the insurance sucks. And belive me...I've had weird dental incidents that my dentist shakes his head over...root canals...cysts on tooth roots and stuff that really were the result of faulty dental practice from years ago...but I had to pay for it all because insurance only covered $1,000 for stuff that costs me way more than that. :shrug:

I'm having it done at U of L dental school -- I could not possibly be happier with the quality and cost. A dental school is 50% less than regular dentist. I guess I am lucky. Cigna Dental has paid for everything they were supposed to. Is there a dental school near you?

I have a crown put on by a student 20+ years ago. Dentist to this day always comment on the excellent qualiy of the work.

my "student" is doing (she graduates in April.) I know I will never have trouble with her work.

dental school for years for his work. he was satisfied.

insurance company excutives have never heard of Atlas Shrugged, Ayn Rand or John Galt. Good luck on that one!! You still end up paying for the procedure. I now how you feel. I'm in the DC area and alot of folks in the dental field won't take insurance, because of the reason you got denied.

Dentist have a right to be compensated for the sthey provide to bad the insurance industry only see a need to take my money but not pay my reasonable expenses.

The other day John Edward talked about a case where a young man was critically sick because of an apsus in his mouth does not rate emergency care and his mother could not afford detal insurance. What he failed to include in his story was the fact that the boy died at John Hophins Medical Center from an aliment that is treatable. I cried when it was on the news in my area.

Paying for insurance via your employer is like russian roulette, you don't know if it's good until you need it. What makes matters worst, most companies don't give you a lot of insurance options.

I can rant all day on his subject. Got to go before my blood pressure goes up and I don't have high blood pressure.

I just had a tooth with a crown on it break off with most of the top of the tooth still cemented into the crown. If food can get stuck, there will be decay at the gum line and a destroyed crown.

It probably would have been caught earlier but have avoided the dentist for financial reasons.

Insurance companies cause more stress than any other business I can think of. They should be sued - class action for causing stress which causes illness.

Boy is this ever a TRUE statement. As I just posted, I've been sick all weekend worrying about the damned bills! :(

I'd love to sue their rich asses for the stress they have put me though. It was real nice, my husband and I managed to get into a fight about this sh*t even for no good reason at all! :(

:kick:

Husband is losing his teeth slowly but surely. He had to have 2 extracted in October (one finally just broke off and was rotted out; the other an ancient wisdom tooth). I received a notice on Friday (wouldn't you know it) that the insurance has not paid for the extractions.

In the meantime, the dentist (a Mr. "In Network" guy as was the guy that extracted the teeth) has put a crown on one of his remaining teeth and also fixed up two other ones left - bill was for $1075.00 so far just from him alone (extractions another $575.00).

He has about several THOUSAND dollars worth of work to have done (another 5 extractions as well) and my god, the insurance, WTF happened to them? They are being paid very well!

The dental insurance is Delta Dental. Have they gone bust or something?

:scared: to even go to any dentist or doctor at this point as perhaps the bills won't be paid (insurance is useless?). I've been sick to my stomach all weekend worrying about these HUGE bills that I have NO WAY to pay being the cost of the insurance is so high there is not much left for anything else.

What a fine country we live in huh? Even if you HAVE insurance - go f_ yourself is the message I'm getting! :mad:

Best of luck to you - WE BOTH NEED IT!!! :argh:

:kick: & recommend!!!

n/t

As I stated in a previous post..... after talking with my dentist, I think it was just incomplete information regarding my two procedures. With me, my wife's plan is with Delta Dental and I have had over 5,000 dollars in work done over the last six years. Mostly crowns so I had to wait for each new year to continue my dental work as two crowns used up my yearly maximum.

Last November was the first time in over ten years that I actually didn't have something to do with my teeth. As far as Delta Dental...we had no problems ever.... it was just having to wait once my max was met.

Take Care and thanks for your post...:-)

Dennis Kucinich promises his plan will cover dental, vision, hearing, and mental health. Imagine health care from the neck up as well as the neck down!

And there's loads of stuff that won't cover. For this "benefit", I pay $50.00 a month, so it works out to my paying $600 a year for them to pay the other $900.

One visit to the dentist can cost that much, although as I say, it may take a whole lot of very expensive visits, thousands of dollars, before they'll be shelling out the full $900.

Why do I bother?

You have my sympathy.

and I get a god damned bill!!?

It pisses me off! I'm going to be on the phone (like it or not assholes) first thing tomorrow morning! This is an absolute disgrace!!!

:kick:

last year it was $45. the medical is up to $120. it goes up every year with higher deductibles and co-payments.

chomp on those apples.

There is nothing left!

Income last year that was taxable was $7500.00. :puke:

himself. of course, his income is way higher than yours. this month he turns 65 and will be eligible for medicare. his wife is still 64.

my sister pays $300 a month for a policy with a $10,000 deductible.

you know the whole damn system pisses me off. the words health insurance makes me see red. we need universal health care. we're the only industrialized country that doesn't have it.

They do NOT pay for an annual physical exam (preventive care). They do not pay for many other things as well. I have not even gone for a physical in about 3 years because I must pay the bill in full myself.

I am so very tired of this whole thing I cannot begin to even say. I am afraid to go to the doctor because I don't know if the bills will be paid.

I was quite recently (Oct.-early Dec.) extremely ill and required 9 doctor visits and many laboratory tests. I have not yet gotten the bills for all of this.

And now I must worry about the damned dentist. I need to have a tooth fixed myself but have been putting it off because I do not have the money for the co-payment right now. I wonder how many others are in this same boat?

Admittedly, I am losing all hope and this "Keep hope alive" sh*t just is not cutting it for me anymore (sorry Jesse).

This whole system here in the USA caters to the rich only . The rest of "us" are mere peons and I feel that "they" can hardly wait to be rid of us all so they can steal what is left from us.

It is very difficult trying to live on so very little. Luckily, (and I never thought I'd say this) my parents were born in the early 1920s and all I ever heard about was the Great Depression. It was always "turn of the damned lights", "clean you damn plate", etc.

I still live this way because it is all I have ever known. I am glad my parents are no longer alive to witness this mess that has become what was once a great nation. It has become only a great nation for the ultra rich.

These rest of us peons can just go to hell is the way it seems to me. :(

so i know what you're talking about.

we have decent coverage as far as coverage goes and financially we're okay, but what scares the hell out of us is long term disability. my husband got coverage through his employer without a physical exam, but they will not cover me because i have chronic fatigue syndrome. his coverage pays a certain amount for a certain amount of time. if one or both of us needed long term care -- god forbid a stroke, a severe car accident -- we could lose everything we have including our house.

it happened to my mother in law. she had a substantial amount of money. she had a stroke and was in a nursing home. everything went, her condo, her money, her social security, my father in law's pension. it all had to be signed over to the nursing home. when she passed there was $1400 left in her bank account. hubby and his sister had to pay for the funeral.

there is something very wrong in this country.

in your case with your income, they probably would tell you that you qualify for medicaid, but i know that story. back in 67 when i separated from my first husband, i was clearing $45 a week after tax. hubby was paying $40 a week in child support. i applied for medicaid. i wasn't asking for money to pay my rent or anything like that. all i wanted was medical care for myself and my 5 year old child. i was told that i made too much money.

when i used the word "they" in the previous paragraph i'm talking about those -- mostly republicans who say everyone gets care if they need it. they have no idea about the people who "fall in between the cracks".

i will gladly pay higher taxes for universal health care. when you think of how much our medical premiums are -- it might just be a "wash".

i don't know what else to say to you except that i wish you well. i hope your health improves and that the insurance company pays your bills.

That is because I worked for many years as did my husband and we have a few things (like a car).

If you have anything at all you don't qualify for Medicaid and you are screwed pretty much.

That is what you get for working your ass off your whole life trying to be a decent citizen in this country. You get a swift kick in the ass at the end is the way I see it.

RE: Long-term care. I have serious questions about this. They say here in the USA 1 in 3 will require it. However, in Ireland they say 1 in every 125 people will require it. Something is very wrong with these figures I'd say.

Moving to Ireland is not an option for us any longer (it was at one time) as things have gotten more expensive there than here and the "free health care" in Ireland is not so "free" any longer either. They've gotten as greedy over there as here (I guess they've been taking lessons from us sadly). A nice assisted living center can cost up to 1,000 Euros a week these days. Yikes.

I did not mean to hijack this thread so my apologies to the OP. (sorry ... really I am).

that's why i told you about my experience.

medicaid will pick up once everything else is gone, but did you ever see a medicaid funded nursing home? OMG.

my uncle was in one. he lost a leg to diabetes. anyway, they put him in some shit hole in coney island, brooklyn. the only joy my uncle had was tv. he loved watching ball games. well the god damn tv didn't work. he just laid in the damn bed until finally he passed. i actually prayed for god to take him.

i apologize to the OP too. but sometimes these threads do lead us in a different direction.

position for your sake....

Just sayin'...

:hi:

insurance, not for years and years and years. Why? Because employees would "abuse" coverage, it would cost too much, blah, blah, blah. Can you image "abuse" of coverage being an argument for Not Providing medical coverage? It's absurd.

With the stories in this little thread alone, it's no wonder a dental thread gets everyone in an uproar.

:hi:

How about this for a novel idea? Make dental insurance a regular part of medical coverage, subject to the same limitations; no more, no less.

That's what they do.
Deny coverage.
Deny claims.
Look for an edge by cleansing their pool of insured people.

And it was an in-network dentist.

denial with a very graphic word picture (in the form of a letter) of her problem and the insurance company reversed its decision.

It doesn't hurt to suggest that you will insure adverse publicity for the company if they don't pay the claim.

BTY, replacing a broken crown is not just for cosmetic purposes. Once a crown is compromised to the point that a crown is needed, it is too damaged for a filling, even a composite filling to handle the stress of the normal usage of your teeth.

for crowns/overlays, root canals etc. Does your plan require pre determination for this type of work?

My plan has a $1500 per yr per person benefit. Routine care x2 per yr is 100% covered. Fillings @ 80% and crowns, root canals etc @ 50% after I think a $50 per yr ded. This is pretty standard for most dental insurance.

Over many years of having plans and processing claims for plans I have found them to be fairly consistent. I have stayed away from DMO plans because they never seem to have any member dentists around here.

I do now feel that they will cover the procedures as my dentist feels that a more detailed explanation should work.

So I hold off judgment till they deny me again...:-)

My mom is always paying huge deductibles or entirely out of pocket for procedures done in the dentist's chair. Her dental insurance is paid completely by her employer, but mine is only paid partly. After doing some simple math, I found it's a waste of money for me to pay the insurance premiums because the insurance covers so few things.

I'd like to know how our health insurance industry got to the point where they provide insurance, but are allowed to exclude things like feet, eyes, teeth, and mental health. And then you buy "dental insurance" and they exclude just about everything but two teeth cleanings a year, and then still expect you to pay some sort of copay or deductible for it. Fixing this BS is a top priority in my opinion.

thinks everything will be ok.

I get so angry about my insurance that I try not to think about it as my health gets damaged due to the stress. I'm telling you, I have half a mind to (edited ...)

:mad:

They sometimes do cover basic examinations, but if you need a crown, forget it- the tooth gets pulled or left alone. The crown has to come out of your (non-existant) funds. That is why so many of the poor have such crappy teeth, and so many missing teeth.

Our insurance company did that when my husband had crown work done. Come to find out our dentist office didn't use the correct numbers or something. They didn't know until I called them about it. Our insurance company was saying it was cosmetic, too. We got them to cover a chunk of the costs.

BTW, I toally agree with you. We need a candidate who would be willing to stand up to these companies.

Thanks for your advice!

i've been thru this fight before. I have excellent insurance but they still only cover half (the dentist part, not the cost of the crown.)

Dental schools sometimes do crowns for a reduced price-- you should give that a try.