Wife needs Apicoectomy. Health insurance coverage? | |
I asked twice before with long descriptions of the procedure. If you are familiar with this, my question is: Is it considered a medical necessity to have this done? My dental insurance only covers $1000 and the procedure is supposed to be $8000. She needs it done on the 6 upper front teeth. I am hoping that my health insurance plan will cover it. She has an active infection in the bone and I feel that it is medically necessary to have this done. What are your feelings on this? I am not interested in an answer from "Biologic Dental Consultant" thank you.
Answers:
1Thank you for saying that about the Bio Dental information they seem to be spreading all over here. As for your question it will need to be determined by the oral surgeon for it to be considered a medical problem and be submitted. In most cases such as your wife's, it is considered as such and the medical coverage picks it up. But I don't know the situation that has caused this and can't be positive, so you should rely on what the OS says.
I don't think obtaining additional insurance will help, as this will be considered a "pre-existing condition" and most all insurance co. have a clause that covers this and disallows any claims submitted. I would suggest just filing for a "pre-determination" (if there is time) to see what and if it's covered. The office manager or insurance clerk at either the dental or Oral Surgeons office will be able, and more than happy to help you with the needed forms and they will submit everything that is required for it to be processed quickly. You just need to relax and spend time and take care of your wife, who I'm sure is very anxious over both the procedure and the expense.
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