Dental claim Question?

My company was bought out in May 2007. My insurance provider before we were bought out was Delta. Under the new care, we have Aetna, and basically thrown into a dental plan as a hew hire.(Technally weren't new hire's though). So, in early November, I had oral surgery done. My Dentist wants over $1100. I was under the impression that my insurance would cover it. WOW. Was I wrong. Apparently I have to be with Aetna for a year, before having major work done. NOBODY Informed me of this. I have the documentation that I was given, and nowhere does it state must wait a year. Can you give me any suggegtions/advice for when I submit my claim letter. I really don't feel like I should have to pay. Thanks in advance ;)
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Interesting. You can write an appeal letter. It never hurts. If you've gotten your EOB, and I'm assuming you have, you'll need to reference the claim number, date of service and all that. Include that along with a copy of your insurance handbook. I'd word it something like this: Dear Appeals Department; I'd like to appeal the decision not to pay my claim for oral surgery on November 2nd, 2007. (See attached explaination of benefits.) The reason stated for denial is "insured must be with Aetna for 1 year prior to major work being done." However, as you can see in the enclosed copy of my handbook, that rule is not listed and I was not made aware of it prior to the date of service. Please reconsider this denial. Sincerely; Me Patient ID 123456 They will have to respond to you. If you haven't already, contact Aetna to get the correct address for the appeal. Also, ask your dentist to do the same. Perhaps he could give you a narrative as to why the work was done and why it was important that you didn't wait until 5/08. Good luck!
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