Not Easily Upset, But.....

**forHISglory** · 03-25-2009, 10:55 PM

I really really don't like my insurance company! Last year I lost a cap on a front tooth the night before we left on a cruise. Fortunately I found a dentist to make a temporary replacement late at night. Then my regular dentist made the the permanent cap when I returned from the cruise. My insurance company will not pick up one dime of it!!

Why? Unicare said that in their opinion, it wasn't worth putting back on, and the dentist should have just pulled the tooth, leaving a nice big gap in my smile. Mind you, the insurance company never saw me, never met me, but they certainly felt they had the right to discredit my dentist.

Today I got the answer to my final appeals process: NO. They won't pay anything. It's not a question of deductibles and co-pay. They just say the dentist should not have put a new cap on my tooth.

So here's my plan. I am going to contact the following with my case, my files, and copies of correspondence:
1. our attorney general of the state
2. Better Business Bureau
3. a state legislator who is a personal friend
4. a state legislator who is a former student
5. the local school board, who selects the insurance company that we use
6. the state teacher's group (since we were teachers and belong to it)
7. a former student who is now an investigative reporter for a large city TV station in our state.

Do you have any suggestions or advice?
Have you ever been in a situation like this?

**Sassyclass** · 03-25-2009, 11:00 PM

Give them the fight of their measly lives. I'll say a prayer for a good outcome.

Cat

**LastDragonfly** · 03-25-2009, 11:10 PM

take out an ad in a major news magazine
call fox news
call all the networks

try to correspond with supervisors go to the top

**Debbie-cat** · 03-25-2009, 11:55 PM

I don't have any suggestions, I think you did very well thinking them up on your own but I sure would be angry! Good luck and I hope they HAVE to cover it in the end.

**Momto2Boyz** · 03-26-2009, 11:12 AM

I hate insurance companies. SO give them a fight! Sounds like you have a really good game plan!

Keep us posted on how things go!

**cojo** · 03-26-2009, 11:16 AM

Often I find with insurance companies you just have to push back and they will give in. I think sometimes they hope you'll just go "oh, ok" and give up on the money.

I chipped my tooth one day and the dentist fixed it. They initially denied it but once I wrote them back explaining it was a front tooth, and highly visible, and there was a risk of my cutting my tongue or cheek on it, they covered it.

**Persimmon Lace** · 03-26-2009, 11:34 AM

Contact your dentist and have them refile it with more detail. That may help with the payment. I would also call the insurance person at your work or wherever you buy your health/dental insurance and ask them for help.

**2ndGenGranola** · 03-26-2009, 01:07 PM

Check and see if your state has an insurance commissioner. Your dentist may even be able to help you (a Dr I worked for had a form letter to send out cc'd to all in situations such as this). I would forward all correspondence to the insurance commissioner. Ins companies don't like ins commissioners on their case. You may even want to see if there is a web site and info for your states ins commissioner.

**rainbowgc** · 03-26-2009, 02:23 PM

That really sux and I. too would be screaming everywhere until I got satisfaction!

**mommy4ever** · 03-26-2009, 02:27 PM

I wonder if perhaps the dentist claim wasn't detailed enough. It should clearly state that the tooth number is, did they need to rework the tooth or just put a new cap on? If there was no further damage to the tooth, I have no idea why it wouldn't be worth redoing.

We are having the same issues with dh. He needs a tooth crowned, however there is a missing tooth, so the dentist wanted to do a bridge. Now the crown would be covered 100%, this would be one of the teeth to be used for a bridge, but as a bridge they only cover about 45%, there's no point in crowning the tooth unless it is *with* a bridge as it's tipping and will eventually fall out. No convincing them otherwise. Insurance can be a real PITA.

**forHISglory** · 03-26-2009, 03:28 PM

Thanks for the tip about a state insurance commission. I'll check that out.

**old_lady_in_the_shoe** · 03-26-2009, 05:02 PM

I would also complain to all of those places, but I would ask my dentist to write me a letter saying that the tooth was viable and worth saving, since HE is the expert. I would include his letter as ad addum because It would show that you were following the opinion of your expert dentist, unlike the insurance company who is just watching their overhead.

I would also send the letter from the dentist to the insurance co and refile for it again. You definitey have a right to be upset.

**lisaflex** · 03-26-2009, 07:38 PM

you need to write a letter of appeal to the company. i am a licensed broker. that way, it will get paid.

**butterflygreen** · 03-26-2009, 08:41 PM

Sounds like insuranc companies.

**forHISglory** · 03-26-2009, 11:28 PM

I have written 3 letters of appeal and my dentist has, also. They just keep turning us down. I talked to the dentist again this afternoon, and they told me to keep fighting and that they would do all they could to help. They were highly insulted by the actions, and they also recommended that I contact the state insurance commission. Thanks again to you all!