Problem With Dental Implant Coverage

by Peter Birdwisa

My wife recently had implants and she used my insurance as well as hers (i have tri care and I am active duty), her practise told her the only costs were her deductible and now we are receiving a bill for much stating that the insurance will now not cover some portions. We were preapproved and we are lost as to what to do next.

Reply:

Hi Peter, I'm sorry you are having this issue. Do you have anything in writing from either your dentist or the insurance provider? It will help if you have something official that shows your portion being only the deductible.

The dental practice should have given you a written estimate before treatment was done and you may also have a pre authorization in writing from both your insurance providers.

If your plans clearly states that the implant should be covered you should keep pursuing the insurance provider for payment. If the dental practice misled you regarding your coverage and underestimated what your cost would be, you can negotiate with them to share some of the expense or at least give you better terms for payment.

When you have double coverage, insurance providers sometimes resist paying (waiting for the other plan to pay). Hopefully it will be easy to clear up. It is worth your time to stay in touch with them (keep calling) until you are satisfied you are getting what you deserve in terms of coverage. Don't wait for the dental office to pursue this for you. Insurance providers sometimes respond better to you (the client) and some dental practices won't take the time to follow up after a clam is denied.

Best of luck in getting this resolved.

Thanks for writing,
~Shelly

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Dental Questions and Answers.

Still Need Some Advice?  Submit Your Question for a Personal Reply