My 11 year old has autism and is totally non compliant with the dentist beyond a basic cleaning. He has some issues that need to addressed and the only way that will happen is in a pediatric OR under full sedation. Our dentist is wonderful, but we know our insurance company will turn down the full sedation (they only cover it if children under the age of 5). We are planning to appeal as there is no other way to do the needed work. I had been told at one time that since our child has diagnosed special needs that would make working on him in a tradtional way impossible, the insurance company must cover the costs. If anyone has any idea on where to look or a link to a site that discusses this topic, I would appreciate it. We live in MD, in case it is a state by state issue, Thanks so much!
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I've been in the same boat. My son is autistic Dental wouldn't cover anything performed at a hospital and health wouldn't cover anything dental. We were looking at about $6000 to fill 3 cavities - all out of pocket. It took getting the dentist to write a letter of necessity for services to both companies and it took many calls on my part. The companies were most uncooperative. I kept questioning why they were discriminating against my son. I guess that worked - they didn't like me using the "D" word and soon agreed to pay between both companies about 80%. It sucked and took a long time and they fought it tooth and nail. I'm with a different employer now and under a different plan. I wouldn't take the previous companies coverage again if it was free because of their attitudes toward the disabled and their needs. They have no idea how much things like this negatively impact their image. Weasels....
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