Seeking Guidance on Dental Insurance Issues
Hi everyone, I’ll keep this brief.
My girlfriend recently received a denial for a periodontist procedure she needs—specifically, a gum graft to address gum recession. As a full-time student without a job, she’s currently covered by state insurance.
For the past 1.5 years, her dental office has accepted her for various cleanings and maintenance, but they’ve been recommending the graft procedure for some time. Unfortunately, due to limited communication between the specialist and the insurance provider, the insurance labeled the procedure as cosmetic, which has led to the denial, even though the specialist asserts it is necessary.
Recently, after confirming with the dental office about her upcoming appointment, my girlfriend was informed that they cannot accept her for the procedure at all, even if she offers to pay out of pocket.
Now we’re exploring options to resolve this situation or find her a new insurance plan through a private provider. She found a potential initial step with Aetna, but a broker made her feel rushed and pressured for information, raising red flags about the process.
If anyone has insights on securing a dental insurance plan that explicitly covers periodontist procedures and can activate quickly, we would greatly appreciate your help! Thank you!
I’m sorry to hear about the difficulties your girlfriend is facing with her dental insurance and the gum graft procedure. Here are some steps you can consider to help resolve the situation:
Contact the Dental Office: Encourage your girlfriend to speak directly with her dentist and the periodontist. They might have experience with insurance issues and can provide documentation or appeal the insurance decision more effectively.
Request an Appeal: If the periodontist believes the procedure is medically necessary, she can file an appeal with her insurance company. Having the dentist provide a Letter of Medical Necessity can help strengthen her case.
Explore Additional Insurance Options: Research various dental insurance plans that specifically cover periodontal procedures. Websites like eHealthInsurance or Insure.com can provide comparisons of different plans. Make sure to read the plan’s coverage details, especially regarding periodontics.
Speak to a Dental Insurance Broker: If the Aetna broker made her uncomfortable, it might be worth seeking another broker who specializes in dental insurance. They can guide you towards trustworthy plans and provide clarity without pressure.
Look into Medicaid or State Programs: Since she’s on state insurance, it’s worth checking if there are alternative programs or coverage options within her state that might cover periodontic procedures better.
Consider Payment Plans: If all else fails, some dental offices offer financing options or payment plans that could allow her to pay for the procedure over time, especially if it’s deemed urgent.
Consumer Assistance Programs: Check if there are local non-profits or consumer assistance programs that help patients navigate insurance issues. They can provide specific guidance and support in dealing with insurance companies.
Public Forums and Support Groups: Online communities (like Reddit or dental care forums) may have members who have faced similar challenges and can share their experiences and solutions.
It’s essential that your girlfriend feels comfortable with any insurance plan and provider she chooses, so taking a thorough approach can help ensure she’s well-informed and supported. Good luck!