What to expect with dental insurance?

[Teggie]

What is the name of your state? Texas

We were carrying a HMO plan (Safeguard) for our family of 5 because it was cost effective at 30.00 a month and seemed to cover most of the things we thought we would need..

However once we got on and got into see the dentist we had problems. My husband is in need of multiple extractions, a full upper denture and a partial lower. He was set up to get the extractions done but on his first extraction visit the dentist had too much trouble and said he would have to see a oral surgeon because his teeth are difficult extractions.

We went to see a oral surgeon listed on the plan and got a quote of 4750 (including 25% less for plan) to do the job. Unfortunatly we don't have that kind of money. The safeguard plan only covers 25%.

We have been talking and researching and it appears to me we will prob need to get him his own insurance to get this done. I researched on ehealthinsurance and found a plan called Security Life Plan III, it's a PPO, 50 dollar deductible and oral surgery is covered at 80% after 6 monthes. It will cost about 30 dollars a month for just him.

I am concerned about what kind of difficulties could arise with this?
Obviously he will have to wait 6 monthes to get the oral surgery benefit. Are we at risk for having it claimed as a pre existing condition?
The denture benefit is at 18 months, we had thought we could get those done at affordable dentures cheaper and they make immediates and just ask the oral surgeon to put those in after extractions without using the insurance for that.
Could the insurance refuse to pay for the extractions until 18 monthes when the denture benefit becomes active because it is workup for denture placment?

We just want to make the best choice we can. I am just afraid something will be thrown on us & I want to be prepared.

Any advice?What is the name of your state?

[cbg]

This is really more of a contract issue than a legal issue. Could they refuse it as pre-ex? Yes, they could. Could they refuse to pay for the extractions? Yes, they could.

However, the fact that they could does not mean they will. It's going to depend on how the contract is written. We can't answer what they WILL do because we haven't read their policy.

Your best bet would be to contact the carrier directly, outline your concerns and ask how it would be handled. Make sure you get the name, title and phone number of the person who gives you the information. Take notes and ask questions about anything you do not understand. Make sure you have a clear understanding of how it will work before you make your decision.

[Teggie]

Thank you, I was just concerned they would scream and say No! Go Away! lol I'll send them a email, thank you

[cbg]

I would recommend doing it by phone rather than e-mail.

First, they are more likely to address your specific concerns (as opposed to a boilerplate response) over the phone. Second, you can't ask questions of an e-mail.

You can always ask the person you speak to, to put their responses into an e-mail after you have talked with them. But I wouldn't use e-mail as my "first contact".