What is the name of your state? Oklahoma
Can someone please tell me when a dental issue becomes a medical issue?
I have had problems getting a bone graft and dental implants approved through my health insurance. The first denial I received stated it was not a covered benefit because it was TMJ. After appealing the decision and pointing out coverage for TMJ disorders, it was denied again, with the insurance provider stating it is a dental issue.
In the second denial the provider stated I could bring civil action as allowed in the ERISA Act of 1974. I plan to do so, but really need to know the answer to my question. Any help or guidance in this matter is greatly appreciated.