 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Dentistry / June 2005Dental Insurance Question - is bonded tooth a pre-existing condition?
I broke off half of my front tooth when I was ten years old playing basketball. I had it bonded and it lasted a very long time. Also, I switched health insurance to Anthem Blue Cross Blue Shield in March, policy effective 3/17/05. When i was eating dinner on 4/14/05, the bonded part of my front tooth broke off. I went to the dentist and had it re-bonded 4/18/05. I just received a letter saying my claim for that procedure has been denied, because the waiting period has not been satisfied. I think they are saying that it is a "pre-existing condition". Should I try to fight this, or are they right? > I broke off half of my front tooth when I was ten years old playing > basketball. I had it bonded and it lasted a very long time. [quoted text clipped - 10 lines] > > Should I try to fight this, or are they right? Call them and ask them to explain this. I see plans that will deny coverage for REPLACING a tooth that was missing before coverage was in effect, but I can't imagine refusing a benefit for a direct restoration of a tooth broken after the insurance was in effect. It may be that you are not eligible for any benefits until a certain time has passed after your enrollment. They should be able to explain this to you in plain English. Steve  SignatureCut the nonsense to reply helpmefigurethisout.com had written: I broke off half of my front tooth when I was ten years old playing basketball. I had it bonded and it lasted a very long time. Also, I switched health insurance to Anthem Blue Cross Blue Shield in March, policy effective 3/17/05. When i was eating dinner on 4/14/05, the bonded part of my front tooth broke off. I went to the dentist and had it re-bonded 4/18/05. I just received a letter saying my claim for that procedure has been denied, because the waiting period has not been satisfied. I think they are saying that it is a "pre-existing condition". Should I try to fight this, or are they right? dentaldoc replies: There's a big difference between a "pre-existing condition" on one hand, and a minimum waiting period on the other hand. Which did your denial letter actually say? Many policies have "waiting periods" which indicate the minimum time the policy must be in force before it will cover certain procedures. Is that the case here? - dentaldoc It said "Reason Code 008 - waiting period has not been satisfied. service not covered." I looked in the terms and conditions for my policy and could not find anything about waiting periods, just pre-existing consitions. Never mind, I looked around some more and found that there is an 18 month waiting period for this type of service. Does it count for anything that I was switching from a group insurance plan (also through BCBS) to an individual, rather than getting insurance for the first time? > Never mind, I looked around some more and found that there is an 18 > month waiting period for this type of service. Does it count for > anything that I was switching from a group insurance plan (also through > BCBS) to an individual, rather than getting insurance for the first > time? If it's with the same company I definitely would complain, esp. if you picked this up as an individual under COBRA. Steve SignatureCut the nonsense to reply If COBRA, do as Steve B. says. If it is an individual policy written for a very small group or no group at all, then a 1-3 year waiting period for anything other than preventative coverage is very typical. They figure any individual buying a dental plan for themselves, must need lots of dental work, so they are making sure they collect enough premium before paying any claims. They probably expect you drop the plan long before the waiting period is up. If you stay with the plan for the waiting period, they figure you will have had the major work done, and their risk will be less. Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> Never mind, I looked around some more and found that there is an 18 [quoted text clipped - 7 lines] > > Steve |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2009 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.