Orthodontics Coverage Denied After Braces Are Installed

[minooka]

What is the name of your state? Illinois, Minooka

I was at work today (friday) and when i got off i had a voice message from my dentists stating that the insurance company denied my coverage.

I dont have the specifics in front of me right now but the jist is.. The insurance company agreed to cover 1700.00 or so life time max . The dentist did all the paper work and installed my braces. I have had them on for apx 4 months now.

Monday i plan to go talk to the dentist. The only thing i know to say is "its not fair". Obviously this wont get me far so i was wondering if anyone has advice on how i should tackle the conversation with the dentist to steer him in the direction i want him to go. The "help me get this fixed" direction.

Also.. does anyone know why the insurance would deny me this late in the game. Obviously they deny everything they can as many times as they can to save money.. What im asking is what reason could they continue to deny me.

I am trying to gather as much info as possible so that i can take charge of the situation.


I found this link.. hopefully my situation is as simple as this one..
[url]http://www.my3cents.com/showReview.cgi?id=17267[/url]

Thanks in advance.

[nextwife]

Did you verify both the coverage AND the provider BEFORE proceeding? And make certain what level of coverage existed, so you could choose accordingly?

[TIMMAAYY]

You don't say whether or not "orthodontia" is actually covered in your plan, which may well be the case. Just because they offer a lifetime max of $1,700 dollars... that doesn't mean for anything you have done.

Does your insurance plan specifically cover orthodontia? Typically they do not.

[cbg]

"It's not fair" isn't going to cut it, you're quite right.

You need to be familar with the terms of the plan; whether orthodontia is covered; if so to what degree; what procedure was required to have it covered; and so on.

This is your only ally. Unless you can go in there knowing that not only is orthodonia covered, but that your orthodontist is a covered provider and that you followed the policy rules in getting it approved, you're licked before you start.

[noisefrazzle]

Just a thought, but when I had braces as an adult my insurance didn't cover them because I was over the age of 19. On its face the policy said braces were covered but in the fine print it mentioned the age exclusion. If you check your fine print it might be there.

NF

[ecmst12]

The FIRST thing you need to find out is the REASON they denied. Until you know that, everyone is purely speculating.