<p>I have United Health care dental coverage, and this year they included implants in their covered benefits, which was great as my DDS recommended an implant. </p>
<p>They are denying the claim, so I plan to appeal. Any suggestions or tips on writing the appeal letter?</p>
<p>What info did they send you regarding the denied claim?</p>
<p>initially just denied it, I called for further info, they requested xrays and a dental narrative, both of which were sent. they are denying claiming a denture could have been done instead.</p>
<p>I thought it was pretty common for dentists to tell ou what insurance will pay beforehand. Will the ins company pay what a denture would have cost?
If they weren’t satisfied with the dentists notes, perhaps if he spoke to them?</p>
<p>^ Times they are a’changing. The last time I needed a root canal, my Endodontist (who is terrific) asked that I pay in advance, then negotiate repayment from my insurance company.</p>
<p>DH is a dentist who is so frustrated with insurance companies frequently changing what they cover and how much they pay that he tells patients that he’ll send in a pre-estimate to the insurance company to see if they cover the procedure and how much.
That way neither he nor the patients are surprised.</p>
<p>^^^
We refer to that in my office as a “pre-denial”.</p>
<p>When I went to get my root canal, I brought my checkbook and wrote a check for the price that they gave me when I met before to discuss the work. I’m pretty sure that I either didn’t have coverage or I had used up my benefits.</p>
<p>I’ve also paid cash for elective dental work (replacing amalgam fillings) or when my benefits ran out for the year. If you want or need something done - you can just pay for it out of pocket. Insurance shouldn’t run your quality of life.</p>
<p>BTW, I don’t have a lot of problems getting appointments in general. Perhaps how you pay for things does impact some aspects of service. I’d rather have the guy working on my teeth not worried about whether or not he gets paid.</p>
<p>I did pay in full for the dental service at time of service. Didn’t know there was any other way?</p>
<p>What the dentists and oral surgeons do in our area, is contact the insurance company to find out what is covered, and bill for the balance.</p>
<p>When the total bill might be in the hundreds or even thousands of dollars, I only want to pay what I owe, not pay everything and then wait to be reimbursed. I already have to do that with medical insurance since a few providers don’t want to deal with insurance.</p>
<p>It perhaps depends on your insurance company on how confident the dentist is that they will be paid for their services, but especially for something major like implants or extractions, we have gotten the written estimate upfront, which allowed us to clarify with the insurance company how much they would pay.</p>
<p>My dentist will do the procedure and bill the insurance unless I just pay for the procedure (usually after it’s performed and insurance company informs me that it isn’t covered). I’ve been with the dentist for long enough so that he knows I’m good for the parts that aren’t covered - even if it’s the whole thing.</p>
<p>In the past, I typically left a credit balance of $500 - $1,000. The reason for this is that the part that I owed would be 30 days past due by the time the insurance company sent them their payment and I’d get a late fee. These days I don’t leave a credit balance there - I just make sure to call them a few weeks after the procedure to pay the part not covered. Google Calender has worked well for that.</p>
<p>OP,
Did you obtain pre-certification before you went for implant? If not, then I do not know what to say, if yes, then they have to pay what they said they would.
i have 6 implants all with different experiences (the same docs though). Working on pre-certifying the crown on the last one. It was all done, but then my Secondary insurance has changed, so dentist had to ask for pre-certification again. I hope I can do it this year. If secondary does not pay, then it will be next year, so tired to eat on one side.</p>