Seeking Help with Dental Insurance
Hello everyone, I’ll keep this short.
Recently, my girlfriend was informed that her request for a periodontist procedure, specifically a gum graft to prevent receding gums, has been denied. She’s a full-time student, currently unemployed, and relies on state insurance.
For the past 1.5 years, her dental office has accepted her for routine cleanings and maintenance. However, the specialist has been recommending this procedure for quite some time. Unfortunately, due to limited communication between the specialist and her insurance, the procedure has been deemed cosmetic by the insurance company, despite the specialist’s insistence that it’s necessary.
This procedure has been in the works for at least six months. Just a few days ago, my girlfriend contacted the dental office to confirm her appointment, only to find out that they are unable to accept her at all—even if she pays entirely out of pocket.
Now, we’re exploring options to resolve this issue or find a new insurance plan through a private provider. She found a potential option with Aetna but is feeling hesitant after a broker pressured her for credit card information without giving her a chance to review the plan thoroughly, which raised several red flags.
If anyone has advice on how we can find an insurance plan that covers periodontist work and starts as soon as possible, we would greatly appreciate your help! Thank you!
I’m sorry to hear about the challenges your girlfriend is facing with her dental insurance and the gum graft procedure. Navigating insurance issues can be really frustrating, especially when it involves health care. Here are some steps you can take to help resolve this situation:
Review the Denial: First, it’s important to carefully review the insurance denial letter. It should outline the specific reasons why the claim was denied and any information required to appeal the decision. If the procedure was deemed cosmetic, the periodontist may need to provide additional documentation to establish medical necessity.
Contact the Periodontist’s Office: Reach out to the periodontist’s office directly and ask for their assistance in appealing the denial. They may have experience with similar cases and can help gather the necessary documentation to submit to the insurance company.
File an Appeal: Help your girlfriend file a formal appeal with the insurance company. This usually involves writing a letter that includes all pertinent information, such as the periodontist’s recommendation and any supporting documents. Follow the appeal process outlined in the denial letter, and keep records of all communications.
Explore New Insurance Options: If the current plan is not working, it could be beneficial to look at other insurance companies. Research dental insurance plans that specifically cover periodontist work. Websites like HealthCare.gov or private insurance comparison sites can offer options.
Seek Help from a Broker: While it’s understandable to feel wary after the recent conversation with the broker, working with a reliable insurance broker can be beneficial. A good broker should provide clear information about coverage options and help guide you through the process without pressure. Be sure to check reviews or get recommendations to find a reputable one.
Consult University Resources: Since your girlfriend is a full-time student, check to see if her university offers any dental insurance plans or resources for students that could cover specialized dental procedures.
Look for State Assistance Programs: Depending on your location, there might be state assistance programs that can help cover dental procedures for those with limited income. Research local programs or reach out to social services for guidance.
Consider a Payment Plan: If the procedure cannot be covered by insurance and is urgent, check with the periodontist’s office about payment plan options. Many dental offices offer financing or payment plans to help make procedures more affordable.
Stay Organized: Keep all documents, correspondence, and notes organized throughout this process to help ensure nothing gets overlooked.
Getting the right care can be complicated, but persistence and thorough follow-up can sometimes resolve these issues. Best of luck to both of you!