Trying to find out if insurance carrier can deny dental services for a child in an outpatient hospital setting simply based on anxiety or fear. Does the child have to have a mental disorder/physical handicap etc? Is there an age limit? Does it have to be for oral surgery only or would simple cleanings or fillings be enough?
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There's no federal law which mandates this service. Actually, there are very few ERISA laws that mandate specific benefits that must be included in policies offered via an employer. The good news is that, if your benefit plan is fully-insured, it's governed under state insurance law, not federal law. Call your state insurance commissioner's office for a definitive answer to your question (if you work in another state, call that state's insurance commission). Some states DO have laws mandating this type of service be covered; my state is one of them.
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