Tuesday, December 28, 2010

Is there a reason dental insurance wouldn't pay for this?

My stepdaughter has dental insurance through her mother at the moment. Her mom is in the air force (I don't know if that makes a difference). She was playing on the playground with her friends and fell and broke her front tooth in half. She went to the dentist today to have it repaired. I talked to her later this morning and she said she didn't get it fixed because the insurance wouldn't pay. Now she is going to have to wait until January to get her tooth fixed. This is unacceptable to me. Why should a ten year old have to be embarrassed and walk around with a broken tooth!? I am sure it is also uncomfortable and painful when she eats. Does anyone know why the insurance would deny this?
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There are several possible reasons, and it's difficult to narrow down without more information. 1) You mention waiting until January to fix it, so there might be a calendar year maximum on the policy. If it's a household policy and someone else had any reconstructive work done, it would likely cap out the policy for the year. They're usually low enough that a single root canal from a endodontist will cap the policy. 2) What level of "fix" was it? Extraction and replacement? Crown? A simple cosmetic temporary filling? I've had significant reconstructive work done on front teeth, and a cosmetic temp only runs about $100. It's not a permanent fix (I've had one hold for 6 years, another for 6 months), but it should hold until January if she's careful with it. This likely wouldn't be covered by insurance since it's a temporary fix, at best. 3) The fact that it's through the Air Force may have something to do with it. While I'd sincerely hope that military families get better coverage than civilian employees, I know the dental benefits I got when I worked for the IRS were pretty bad.
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