insurance denied

[wpwbeef]

dystonia diagnosed in my chin. neuroligist sent me to dentist[prothosis specialist].dentist is treating me successfully for a confirmed medical condition; but insurance company,[blue cross] refuses coverage[payment] because i do not have dental coverage in my health insur. plan;even though treatment is for medical condition. HELP!

[Gymnast_Navy_Wife]

I am not sure of the way your health plan works, but if it is anything like mine, you need a referral from your doctor and then pre authorization from your insurance company to see any sort of specialist. Did you get preauthorization ?

I think your in a tricky situation-- there are many, many medical things/causes that create dental problems, and for the most part-- even given that fact, insurance will usually not pay for it. I have had multiple dental issues that have been in a large part due to medical conditions and/or the effects of the medications I take for them. However, my medical insurance has only covered one of those: when I was thought to have-- and was later diagnosed with, TMJ . In some cases-- such as mine, TMJ, is considered a medical condition and is treated by both a TMJ specialist and my doctor. My primary care doctor did the whole referral/authorization process and then my insurance company sent me to someone. (Even though I had dental insurance; my dental insurance played no role in the TMJ stuff.z0

So, my suggestion would be to get a copy of exactly what types of medical conditions and services your insurance covers. All companies have their own guidlines and policies, and it is your right to have a copy of it to read over.

Then, I'd contact the benefits specialist within your insurance company and discuss the situation with them.

Good Luck !

[chele]

Just about anything to do with the mouth/lips/gums is considered a dental issue - even when you have an abscess!

[michael178]

Almost every state has a department of insurance. File a complaint with then. Their job is to represent you and make sure your company is doing what it is suppose to. That doesn't mean they will rule in your favor...your treatment has apparently crossed over the line from purely medical to dental... and that become a grey issue in terms of coverage