Seeking Help with Dental Insurance
Hi everyone, I’ll keep this short.
Recently, my girlfriend was informed that her request for a periodontist procedure—a gum graft to prevent receding gums—has been denied. She’s currently a full-time student and unemployed, relying on state insurance.
For the past 1.5 years, her dentist has accepted her for various cleanings and maintenance, but the specialist has been recommending this necessary procedure. Unfortunately, due to limited communication between the specialist and the insurance company, her procedure has been labeled as cosmetic and denied, despite the specialist arguing otherwise.
After having this procedure scheduled for over six months, my girlfriend recently called to confirm her appointment, only to discover that the office can no longer accept her, even if she pays out of pocket in cash or check.
We’re now looking for ways to resolve this issue or find a new insurance plan through a private company. She’s considering Aetna but is hesitant after a broker pressured her for information without giving her a chance to review the plan. This raised several red flags for us.
If anyone has suggestions or information on insurance plans that cover periodontist work and can activate quickly, we would greatly appreciate it! Thank you!
I’m sorry to hear about the challenges your girlfriend is facing with her dental insurance and the gum graft procedure. Here are some steps and suggestions that may help you navigate this situation:
Contact the Insurance Provider: If your girlfriend has a state-issued insurance plan, reach out directly to the insurance provider to inquire about the specific reasons for the denial of the gum graft procedure. Ask for clarification on why it was classified as cosmetic and whether there’s a formal appeals process.
Get Documentation from the Specialist: It’s important for her periodontist to provide detailed documentation justifying the medical necessity of the gum graft. This document can help in the appeal process with the insurance.
File an Appeal: If you’re able to, assist her in filing an appeal with the insurance company. Most insurance policies have an appeals process where you can contest their denial. Include any letters or documentation from the periodontist supporting the need for the procedure.
Explore New Insurance Plans: If deciding to switch plans, research different dental insurance providers. Websites like Healthcare.gov can help you compare plans, including what types of dental work they cover. Make sure to read the fine print, especially regarding periodontal procedures, before choosing a plan.
Seek Second Opinions: If she’s comfortable, she could seek an evaluation from another periodontist. Sometimes a different perspective can help in dealing with insurance or even provide alternatives for treatment.
Consider a Dental Discount Plan: If traditional insurance is proving difficult, dental discount plans might be an option. These plans typically offer reduced prices for various dental procedures and might be easier to use than insurance.
Local Resources: Check if there are any dental schools or community health centers in your area. They often offer reduced-price services provided by students under supervision.
Stay Informed and Cautious: Regarding the broker from Aetna, it’s wise to be cautious. It’s okay to take your time to review a plan, and legitimate brokers should respect that. Look for independent reviews of the broker or the insurance plan before proceeding.
Hopefully, these steps can help you both find a solution quickly. Wishing your girlfriend the best in getting the care she needs!