How DMO dental plan works?

I have two dental plans. The primary is metlife PDP, the second one is Aetna DMO. Recently I did an onlay and my dentist is in both networks. The dental office filed a claim to metlife who will pay 50%. While waiting for the EOB from the primary one, I called Aetna to confirm how to file the second claim for the remaing balance. I was told that Aetna pays the dentist monthly fee under DMO plan no matter if we have service or not. But if we do have service, Aetna won't pay any additional fee. Therefore, the dentist or I won't get any payment for this service. This is so confusing. I then called Aetna again and talked to another agent. The answer was totally different. They are saying that they will coordinate with my primary insurance and send a check within their benefit allowance. Which answer is correct? Anyone here familiar with how DMO works? Thanks!
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Dental insurance companies suck! They're in business to keep money in their own pockets. The situation you're in is very common. I owned my own dental practice for 8 years. It can be very difficult to estimate costs for patients' when they have dual insurance. I had lots of problems, where the insurance companies didn't want to pay and the patient didn't want to pay and we all went round and round for months. With my front office manager and the patient getting very upset. I resolved this by anyone who had dual insurance, I only filed the primary and the patient paid me the difference. The patient would then file their secondary claim themselves. When the secondary claim paid, it was paid directly to the patient. When I didn't do it this way problems went on for as long as six months. For your particular situation I would recommend reading the fine print of both of your policies. Keep good notes of everyone you talk to, dates, time, names, etc. Try to talk to supervisors only. If they don't pay and many months go by, you may want to sue.
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i was hit on the mouth about a week ago. now my adult tooth is loose. what can i do not to lose my tooth.?

i have no dental insurance, the gums are not dark and it bleeds when i brush
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I would like to suggest you get as much information as you could before taking action,here http://www.HealthInsuranceIdeas.info is a good place for that.
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I need some advice on extreme dental pain/problems.?

So i'm in a very bad predicament. For nearly the last five months i've had extreme dental pain. My wisdom teeth have decided to grow through my upper molars. Seriously, my molars shattered and little pieces fell out over the past months, now there is a small bit of them left and the tips of my wisdom teeth. Or so that's what it seems like/feels like to me. I could be wrong, i'm no dentist. But the last few nights I've woken up screaming in tears within an hour of falling asleep and remaining awake all night. Problem is I have no way to deal with the pain. Orajel doesn't work, Tylenol doesn't do anything, Lortabs, Valiums, Vicodin. Seriously nothing helps. I just rock back and forth and hope it stops. I cannot go to the dentist, I have no insurance and I have zero money. I was laid off my job a week before I received insurance and unemployment. Now things are terrible, I live in the most unemployed county in Alabama, so money isn't coming any time soon. And my parents won't help out. Dentists here will not take you unless you have proof of insurance up front. It's terrible. I'm very afraid of getting an abscess and dying. But more or less I just want the pain to stop. Any advice? Thanks =]
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Ok, this may sound wierd, but take a spoonful of castor oil and drink it. It soothes you up. Then take some ghee (This is just butter melted and left to boil until it becomes a brownish color) Rub it on your stomach and sleep. This will help sooth the pain. Then take an advil, and a sleeping pill, then have patience. wait to go to dentist
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how to apply for dental blue for mass.?

when it comes to insurance i keep getting the run around. i can find applications for everyone else and their momma (other states). i'd like to apply for blue dental for mass.when i did finally found a site that has an application however now they say they don't cover my area. my dentist office right up the street takes it and they (bluecross blueshield) have an office in a mall up the street from me as well. which i did call but the phone just keeps ringing. can anyone who has applyed for or have dental blue mass help a girl out, please? or even delta dental for mass.
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Get as much resource as you can maybe is one option,however it could be quite time consuming,here http://www.HealthInsuranceFree.info is one resource i have had good experience.
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my teeth are really bad?

I want to get dentures but am so afraid to get all my teeth pulled does it hurt really bad.I need to before my husband retires and we have dental insurance.i cant get the ones that are screwed in as my bones are disintegrating.Plus how easy is it to eat anything.Any help appreciated
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Why do you want your teeth pulled? It sounds like you have periodontal disease if your bones are"disintegrating" as you put it. If you are losing bone and the teeth are loose it shouldn't hurt too much . It's one of those things you'll just have to do, if that's what your dentist said. Sometimes it takes a while to get used to dentures, but the dentist will adjust them as needed. You should be able to eat whatever you want once you get used to them Good luck
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I need an extraction and the tooth replaced, but don't have $3-5000! PLEASE Help!?

I don't have dental insurance and every dentist I have called requires payment in full. I don't qualify for the CareCredit Program and I don't have 3-5 thousand dollars to spend either (which is what I have been quoted), but I HAVE to get the tooth replaced so I continue to look professional at work. ANY ideas or suggestions would be helpful, PLEASE. Thanks friends. -Desperate in Boise
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Put it on any credit card and pay what you can on it. Or see if there is a dental school in your area...they tend to offer discounted rates.
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I am in a dental emergency, any advice?

I just found out that previous dental work has left me vulnerable to much infection. When I was much younger in H.S I was taken to have three root canals, but I was never taken back afterwards for the crowns. So as a result the teeth ended up decaying and falling out, and now my roots are exposed and have been for many years. Now, I have been developing more problems, like a cavity, 2 abcesses and of course infection. Dental work is beyond expensive, especially w/o healthcare.I tried the public health system but their availabilities were very low. The dental school is trying to get over on me with the costs. I am unemployed and have no fulltime prospects; so no potential solid insurance right now. Im in need of emergency care, please if anyone knows something let me know. I am located in Philadelphia, PA. Thankyou.
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I would definitely suggest speaking to dentists and working out a payment plan, if that's a possibility, They are very considerate and believe me, they are willing to work with you. There is probably, also, a government health plan so I would suggest talking to someone about getting on the health plan. I know that in Texas we have one, so you could look online and fill out an application. It might take a while but they will definitely take you in, especially if you're unemployed.
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Free or low cost dental care in Pennsylvania.?

I don't have insurance and I think I have a cavity. I want to get it filled before it gets worse. According to the Department of Public Welfare website, we should be eligible for medical assistance, etc, but we can't get approved. Anyway, I want to know if anyone knows how I can get some help with dental care. All of the dental clinics and dental universities are too far away from me. Thank You. ***Please don't give me stupid, cocky answers***
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The two options i think you ought to try are... 1. Dental Schools. 2. Discount Dental Plans. There is no deductible. They are very inexpensive to join. You are automatically approved, and most start right away, (i know for sure the one at www.1dental.com does for sure). Given your situation i would recommend looking at a discount plan, because you should have quite a few different options for dentists, instead of just schools. Just on a dental discount plan make sure that the prices are pre negotiated and the dentists have agreed to those prices listed on their website (some negotiate prices differently for all dental offices). Again given your situation, i would check out 1dental, mainly because they have the monthly option which is just 6.95 a month, and it does start right away and and the prices are the same for all of their general dentists. Another one i have heard good things about is the aetna. Just check out those discount plans, but also check out universities nearby. Hope that helps. *edit: If you are going to ASPEN DENTAL be sure to get the discount plan before they do proceedures outside of the ones you are getting for free. I know for a fact they take the Careington 500 Plan available at 1Dental.com, and a lot of the savings on procedures are around 50% or more.
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Question about a health insurance claim?

I got new health insurance about a year and a half ago when I started a new job. I was sent a dental card and a medical card in the mail not a vision card. Turns out that was by mistake, I was supposed to get a vision card too (doesn't make sense, why not just give me one card!). Anyway, I have a medical condition with my eyes and I guess growing up my parents would put some of my eye exams under medical not vision coverage. I went in to get a check up at my eye doctor. I hand them my insurance card and they ask for my vision card...immediately I'm confused because I know I have the vision insurance but didn't know I had to give them a separate card. So I proceed to explain that growing up sometimes due to medical issues it was billed under medical. They say ok, just send us your vision coverage info later and we will get you squared away. I paid a small fee that day and called the next day to give them all my vision info. Now a month later the doctor sends me a bill? I called and asked and they said the medical coverage denied my claim. I didn't even know how they filed it since I gave them both a medical and a vision card. I called my vision insurer and they said it was the medical people that denied it not them. The vision insurer said tell them to send the claim and we will pay for it all. I call the doctors office to explain and they say they can't send the claim through as a vision claim because they already sent it through as medical. The doctors office said they cannot and will not, they aren't allowed they tell me I call the insurer to tell them this. The insurer says that's bogus. They call the doctor and request them to file a claim. The doctor tells them they can't file the claim as vision because it was a medical procedure? I just had a routine eye exam and a refraction. That's what I got and that's what the doctor told me to tell my insurer. Now when the insurer calls and asks they say otherwise. The bill the Dr sent me has no codes or info explaining what the charges are for, it just lists insurance companies and dollar amounts. I'm going to request a more detailed bill. The secretaries haven't been helpful or nice. I don't see what's going on. I mean I have the insurance why can't they just file it? Why would they just start doing procedures on me without my consent? If they preformed something other than a general eye exam I should have to agree to it first. Any advice?
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you need to do 2 things...file the claim yourself & get a new doc;; when you file your own claim, you'll have to end up paying the doc, then have your eye insurer reimburse you;; this IS a little funny on your doc's part;; but if I were you, I would contact your medical & see what resolved from the claim before you do anything else;; if he already claimed the medical & they paid..well, that's the ONLY reason I can understand why he may not make a second claim to the right party, your eye...good luck, but I would seriously change docs...
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Orthodontist payment help?

I am in need of braces and my parents cannot afford them, due to the fact I have no dental insurance. I saw a commercial on the television advertising great orthodontist care in Bucks County and you wouldnt have to pay a down payment. I thought this was great, but I can`t remeber the website or number. So do you know of a way to get finacial help for going to an orthodontist in Bucks County?
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alot of orthodontist offices are actually very affordable.. I live in florida and my husband just got braces for 129 a month.. no down payment.. call and see if they have a monthly plan that you can sign up for or qualify for.. its easy and much better than paying full price all at once...
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Is this considered dental fraud?

I recieved a check in the mail from Delta Dental (ppo) for the amount of 1500.00 and I deposited this check into my bank account and spent the funds. I deposited this check with the assumption that it was an overpayment from the insurance company because this has happened a couple of times before. Any way, I called in today to get my receiept for my FSA payment (monthly payments) and they asked me for the check, I was shocked when they told me this and then I realized that the check was supposed to go to them. They are now saying that I committed insurance fraud. Is this true? I am in no way denying that I owe the amount, I just dont have the funds to make this happen right away. Not to mention most of the work that they are billing me for hasnt even been done yet. (started root canal and was supposed to restructure and crown it but havent restructured or crowned it yet)
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You did not commit insurance fraud as far as I can tell. A light should have gone off in your head that you got a $1500 payment to you from an insurance company. Now you are responsible for the full amount to the dental office. I'm guessing payable at the time of service. You may not owe for the buildup and crown yet, but if the root canal was started, you owe. The office's mistake was letting the check be sent to you instead of them. Regardless, the insurance contract is between you and your insurance company, not the dentist. Pay your dentist immediately.
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Is Clearchoice Dental Implant Center a good choice for implants?

I need complete dental restoration. I was very impressed with ClearChoice, but I don't know much about dental implants or whether I should trust them with something as crucial as my teeth. I'm 31 years old, and I'd rather not end up toothless or with dentures, not to mention that the procedure is at least $20,000 and not covered by insurance. If they're not the best choice, what is a good solution for this sort of problem? (I live in Austin, TX).
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Dental implant surgery is very safe nowadays. My cousin got her dental implants and Lasik surgery in India by a company called Indian Health Guru Consultants. The Price for dental and Lasik surgery is very less in India. She paid 25% of the price she was quoted in America. Indian Health Guru Consultants is very famous in India They arrange Dental surgery, jaw surgery, Lasik eye surgery, Dental Implants etc for foreign patients in India. I read a lot about them in the Newspapers and magazines- about their patient stories. They arrange financing for USA, Canadian, UK and other international patients who plan to have surgery abroad for low cost, as dental and eye surgery is not covered by insurance. They also have photos pasted of their International patients. You can checkout their website. There are huge cost savings. As a doctor I personally believe that surgery can be easily handled in India, as the quality of healthcare available In India is simply best in the world. The surgeons are USA/UK trained and facilities are 5 star. http://www.indianhealthguru.com Hope this helps.
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Is this insurance fraud and should I report it?

I had a very bad experience at my last dentist's office and walked out. The appointment was for a routine cleaning and exam. The dental hygienist was very rough and rude to me so I asked to see my dentist. They told me she was on vacation! I didn't understand why they had me come in when my doctor was out. Now, a year later, I have come to learn that my former dentist's office billed my insurance. I started looking into it when my current dentist's office sent me a bill for my last exam because I exceeded the number of cleanings covered by my insurance. I just sent in an appeals letter to my insurance company stating that the exam and cleaning did not take place a year ago. One of my friends told me the dentist's office is committing insurance fraud. I'm not looking to pursue legal action until I hear back from my insurance company. Until then, can I report it to an agency or organization, such as the Better Business Bureau? What are the possible outcomes?
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That doesn't sound right. I have to agree with a previous poster. I think you should try to contact your old dentist first before taking legal action. If you can resolve the matter with her, you can save yourself a lot of potential headaches. If that fails, you can try contacting your state insurance department. Insurance commissioner web sites will usually have a form on the web or one that you can print out to file a complaint. You can find your state commissioner web site through the national association of insurance commissioners. Just click on your state. As for the better business bureau, well, they are also an option, though to be honest, I have not heard the best things from other people in regards to them actually getting things done. However if you report your dentist to them, she will at the very least be exposed as being fraudulent. I have included the insurance department website below, as well as another page that you might be interested in reading, which discusses the signs of dental insurance fraud. Hopes this helps. Good luck.
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Anyone gotten dental work while pregnant???

i have to go to the dentist in 2 days to have a cavity fixed and a filling put in. i almost dont want to go because im afraid it will harm my baby. my ob said dental work is fine. but im still paranoid. so what to do? go or not? the problem is, my insurance stops in 2 months, so i wont be able to get my teeth problems looked at for a good long while after that. maybe never again lol. anyone else had dental work done? fillings, anesthetic, etc???
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My daughter had dental work while she was pregnant, and my grandson is absolutely perfect. My daughter's dentist is a woman who was pregnant with her second baby, and she had no concerns about pregnant women getting routine dental work and fillings. Your ob-gyn and your dentist are the two medical professionals who know you and your health history best. If they say it's okay, then go on. ESPECIALLY since your dental insurance is going to end!
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the dental school is retreating my root canals there is an infection underneath in bone pain help?

they cant really do nothing for pain they gave me some vicodin like week ago they suck and make me sick ive been to hospital like 3 times for this injection of like novacaine and it works wonders idk what to do in such pain should i go to hospital theres nothing the dental school can do there just students hes retreating it and the pain is going away but everytime he works on it and puts medicine in it he agrevates it and it hurts so bad and sore for about 5 days dont know what to do my next appointment isnt for like a week cant get any earlier because its dental school should i go to hospital and get like novacaine shot and maybe they can give me stronger pain meds im not even looking for pain meds i want that shot but i been to hospital like 4 times already in past 2 months but my insurance doesnt really care but idk wat to do
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Tell your insurance co that you are in great pain with an infection.Go back and tell that dental school to give antibiotics to fight infection.
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Why cant health insurance work like other insurance?

Wreck a car, pay a set deductible done. Need a rental? Your policy covers, done. Car breaks down, warranty covers, done. Health insurance- you have a $10.00 co pay, paid, but we charge $75.00 but your insurance only pays $25.00 so you owe us $50.00 and they only cover 2 a year so you owe us $425.00 It is things like that I want changed. I want a national healthcare. Government regulated, not ran. If per incident charges exceed $5000.00 then this policy kicks in and covers. Just like car insurance does. Clear set understandable rules. And flex savings that don't go away at years end to pay for glasses, dental and prescriptions, that cost us citizens the same as in Canada or on the Internet. IT WAS GOVERNMENT THAT GOT US INTO THIS!!! THEY NEED TO GUIDE US OUT!! Employer-based coverage came about during World War II under FDR as a result of the National War Labor Board's decision to institute wage and price freezes in an attempt to prevent production shortages due to labor unrest or inflation. The freeze was not applied to fringe benefits like health insurance, allowing employers to compete for skilled workers by offering ever-increasing health insurance coverage. Workers grew accustomed to receiving health benefits from their employers; making employer-provided health benefits became an American institution AND YES THEY SHOULD BE TAXED, By taxing them they are back to income not a hidden source for the wealthy to play and not pay And when you check out of the hospital, or leave a doctors office, bill must be presented in full at time of check out or it is no longer owed. No more three-month latter you owe a or that. It wouldn't fly at a motel or at a restaurant should not be allowed in healthcare
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FACT - Insurance companies in the USA admit to pushing up prices, buying politicians and not paying out claims when they should That is why. Click the first link for more on that. FACT - PER PERSON the USA spends more on healthcare than any other nation on the planet FACT - Obama debated his plans before the election for healthcare FACT - the chance of a child under five of dying in the USA is greater than industrialised nations with universal health coverage FACT - Obama was elected by the American people to bring in change FACT - Obama wants to stop insurance companies from screwing the American people FACT - The reforms Obama wants work in the Netherlands and Switzerland
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I need serious dental care/ restoration. Can not afford, can not get approved for loan. Help?

I have severly decaying teeth,mostly upper front. One actually broke off a couple weeks ago. Problem: I don't have insurance, tried to get approved through care credit, got turned down b/c my husband & I do not fall under the poverty lines for welfare. I tried another state program but they do not cover dental. I am willing to do anything (within reason) to have these fixed. I'm pretty sure i need dentures. I am 31 and have 3 daughters to support. This has been a problem for about 3 years and I cant take it anymore. I wrote to talk shows, local dentists, everything. For 3 years I have been covering my teeth with temporary dental filling to hide the decay and missing pieces. If there is a dentist out there willing to help me you will never find a more grateful patient (or more scared). I will pay for a plane ticket and you can use my disgusting likeness in advertising. I know there has to be someone with a good kind heart out there. Please refrain from posting snide comments. You do not know how much physical and emotional pain I am in on a daily basis. This is not from lack of dental hygene. God bless!
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Mj is right, definitely look into dental schools for low-cost care. Also, have you looked into medicaid? Even if you are "over-qualified", see if they have any other options for you. I'm very sorry that you've had to suffer through this - tooth pain is the absolute worst. Best of luck to you, and even if I haven't helped, I hope that you find someone who can.
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Best dentists in Fort Collins CO area?

Do you know any good dentists in this area. I have a dental phobia (seriously) and I have 2 cavities that were taken care of awhile back. One of my fillings fell out and I am in a ton of pain because there's a small hole in my tooth. I have Aetna health insurance with dental, IDK how much it even costs out of pocket if they don't take it. I just want the best for a coward like me, lol.
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Our dentist takes Aetna and is a very gentle and has a calming personality. I had a severe dental phobia from a very traumatic dental experience as a child and this dentist has been very accommodating and makes sure to take his time with every procedure and explains in detail what he is doing and how it will feel to you. I hadn't been to the dentist in nearly 10 years because of my fear of dentists and while he gave me a bit of a hard time about it, he listened to my concerns and made sure I was comfortable during the entire procedure. His name is Steven J. Koehler. His phone number is 223-6101 and his website is www.smilefortcollins.com With our Aetna plan each filling was between $60 and $125 out-of-pocket. The depth of the filling and the work required to get them out will determine the price. I had to have an old filling pulled out and a new one put in and it was $90. They also do all the processing for you, so you just have to fork up your co-pay and go home and nurse your sore mouth. Good luck. I hope you like Dr. Koehler as much as we do.
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Received dental work I didn't want. I told them I didn't want uncovered procedures, they did it anyways.?

Recently, I went for a dental checkup. When the dental assistant was about to give me x-rays, I told her I didn't want any procedures that weren't covered. She seemed to take note of it. Then about 10 minutes later she was giving me $200 worth of x-rays that weren't covered, which I discovered when I received my bill. She told me AFTER the fact when I called to inquire that knowing what the insurance covered was my responsibility. This seems like a total scam that a professional would do something like this. Do I have a leg to stand on to dispute this?
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It's pretty bad business, but the insurance is your responsibility. A dental office deals with so many different plans and coverages, it's impossible to know what's covered and what's not covered for each individual. You have to stay on top of it, not the dental office.
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Pet Insurance Selection Help?

Hi, I recently brought my 7 year old female chihuahua home and now I am shopping around for insurance. For those of you with "older" dogs, which provider and plan do you recommend? My dog is in great health (albeit, she can stand to lose a pound). I think I am leaning towards getting her VPI Superior Plan with Well Care Premier. It includes everything from her getting hit by a car and broken bones, to developing cancer, to the basics (like dental cleaning and vaccinations). It seems like a good idea to get all of this but for the dental cleaning and vaccinations, do you think I am just better off paying out of pocket for those procedures (I've never had a dog before so I would not know)? Does she even need dental cleaning if I scrap her teeth myself?
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I use VPI for my dog. My husky is 6 years old and my pitbull/bull mastiff mix is 3. www.petinsurance.com I did about a whole year of research and found them to be the best. they are one of the only insurances that do exstensive cancer care. meaning after the regular 6 month coverage if you have the exstensive cancer care package ( only a few dollars extra month) they will help take care of it for the remaining life of the dog with up to i believe 15000 in cancer treatment. THere in only a 1 time 50 dollar deductible per incident so if you have to go back for the same incident once you only have to pay th 50 one time. and they give you back 90%. THey give you a quote and everything. they even have discounts for any additional pets. they also are the only pet insurance I know about that cover exotic pets like rabbits birds lizards and theyre service is international. As well as you choose your vet they dont have certain places. of course there are some rules no hereditary or pre exsisting illnesses but if your dog is healthy like you said there should be no prolem. and they are really inexspnsive.
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Know of any Insurance that covers my list?

Eye Exams, dental, pregnancy/maternity, prescriptions, doctors visit
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Blue Cross, Aetna - check your yellow pages for Medical Insurance companies.
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Is pet insurance worth getting?

I have asked a couple of questions already regarding pet insurance, but I just want to flat out know if it would be worth getting or a waste of money? I have 9 (8 right now but will be getting an australian shep. puppy soon to make 9 total) animals but only 8 that are eligible to be on pet insurance. They are: A 5 yr old dachshund, 7 yr old dachshund mix, *soon to have* 9 week old australian shepherd puppy, 3 yr old cat, 2 yr old cat, and 3-1 yr old cats. Every month I buy flea treatments and heartworm prevents. And once I get my aussie puppy I will have to get her the puppy shots and the whole 9 yards with her. The two that I am leaning toward are: *ASPCA pet insurance and the plan I would get would be the Level 4 Coverage which covers accidents, illness, wellness and wellness deluxe-which would cover the flea and heartworm products. It has an annual deduc of $100 which will only have to be paid once a year per pet...not incident. A max incident benefit of $5,000. And a max yearly benefit of $13,000. 80% reimbursements. And it would cost me around $526/mo. *VPI pet insurance and the plan I would get would be the Superior w/ CareGuard Premeir & Enhanced Cancer. It would cover common problems (vomiting/diarrhea, allergies, upper respiratory, skin infections, etc), panic-moments (hit by a car, attacked by an animal, foreign body ingestions, heat stroke, seizures, etc), expensive problems (back problems, cancer/tumors, cataracts, feline leukemia, etc), routine care (deworming, vaccinations, flea & heartworm, FELV/FIV tests or heartworm tests, etc), additional care (dental cleaning, spay/neuter, etc) and enhanced cancer care which increseases the policy's reimbursement benefits. This plan has a $50 per incident deductible. It would cost me around $348/mo for all of them to be on this plan. *Which do you think would be better? Or like I asked before, would it be worth it to even get pet insurance? Thanks!
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Picking an insurance plan: While cost of the premium is an important factor to consider, you must make sure that any plan you pick has good coverage. Getting a pet insurance plan without good coverage will leave you unprotected. Let me start out by saying that you want to purchase a plan that covers accidents/injuries AND illnesses. The illness part of the coverage must include: 1) Coverage for Cancer 2) Coverage for Chronic Disease Chronic diseases are illnesses that have long duration and generally slow progression. Chronic diseases are usually not curable. Examples include: cancer, heart disease, chronic kidney disease, and chronic liver disease. 3) Continual Coverage for Chronic Disease If you do not get this coverage, the chronic disease will only be covered in the policy year it was diagnosed, after that, you will have to pay for any continuing medications or diagnostic monitoring yourself. Treatment for most Chronic diseases will last beyond the first year of diagnosis. 4) Coverage for Hereditary & Congenital Diseases 5) Coverage for Diseases that are Common to your Pet's Breed Health issues that Australian Shepherds are prone to include (but are not limited to): Hip Dysplasia, Progressive Retinal Atrophy, Collie Eye Anomaly and Juvenile Cataracts (all of which are hereditary/congenital). Health issues that Dachshunds are prone to include (but are not limited to): Intervertebral Disc Disease (IVDD), various hereditary/congential conditions, hypothyroidism, and Cushing's disease. ASPCA does not provide coverage for congenital or hereditary conditions including hip dysplasia. Also, you must purchase Continual Chronic Disease Coverage as an add-on (It doesn't come as part of the Level 4 plan). Hypothroidism and Cushing's disease are considered Chronic diseases. VPI provides limited congenital/hereditary coverage, including NO coverage for hip dysplasia. In my opinion ASPCA and VPI will not provide you with the coverage you need based on the breed of your pets. They may have been cheaper compared to other plans, but they are cheaper due to the limitations in coverage. Is Pet Insurance Worth It: The sole purpose of pet insurance (or any insurance) is to offset an unexpected, financial hit. Whether or not pet insurance will save you money in the end depends on whether or not a costly medical problem arises during the life of your pet. Costly financial hits in veterinary medicine come in the form of: 1) Emergencies (e.g. Fractures, Accidental Poisonings, Foreign Body Ingestion, etc) 2) Chronic diseases (e.g. Heart Disease, Liver Disease, Cancer, Chronic Kidney Disease, etc) 3) Sudden, Severe Diseases (e.g. Pancreatitis, Leptospirosis, etc) The costs will vary based on geographical location. Big cities tend to have higher vet costs than rural areas. Start by asking your veterinarian "what is the highest cost you can expect from the three scenarios above". In big cities, these "Worst Case Scenario Costs" can range from $3,000 - $10,000. I have seen a case where the bill reached $20,000, but at this time this is more of the exception rather than the rule. If you can afford the costs out of your own pocket (using credit cards, savings, friends, etc) then you may not need pet insurance. If you cannot afford the costs, then pet insurance may be something you want to continue exploring. Hope this helps :-)
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Use of full sedation for dental surgery in children with autism...?

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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Health Insurance question?

Ok, in the past I made the mistake of purchasing a health insurance (I neede it one because I was pregnant) Now, i want to do some yearly exams, and here in Florida we have an option (miami). I am a little clueless about insurance info. Would you please read this and let me know what all means? what it covers>? specialist? what is the co payment total CYD + 10%? Thanks Cost Sharing Calendar Year Deductible (CYD) (per person / family aggregate) $250 per Individual Coinsurance (Amount you pay) 10% of allowed amount Out-of-Pocket Maximum (per person / family aggregate) $2,500 per Individual Calendar Year Deductible (CYD) for Dental Benefits (per person / family aggregate) $0 Deductible Other Benefits Physician Services $50 maximum applied towards the visit Well Child $50 maximum applied towards the visit E-visits $50 maximum applied towards the visit Urgent Care Centers $50 maximum applied towards the visit Rx Benefits - Retail Generic drugs: $10 Copayment Brand name and non-preferred drugs: discount only Rx Benefits - Mail Order Mail Order: Generic, Brand Name, & Non-preferred Drugs are not covered Inpatient Hospital Facility Services (per admission) CYD + 10% Coinsurance Physician Services at Hospital & ER CYD + 10% Coinsurance Independent Clinical Lab $0 Copayment Outpatient Hospital Facility Services (per visit) CYD + 10% Coinsurance (surgical and related services only) Dental Benefits $50 towards the visit for basic and preventative care Emergency Room Facility Services (per Visit) $500 + CYD + 10% Coinsurance (for non-surgical services only) CYD + 10% Coinsurance (for surgical services or admissions)
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This policy seems to have many restrictions and maximums. Makes me wonder what else is restricted in the fine print. This might be OK depending upon what you need and what the premium is for the policy compared to other major medical plans. You should contact a local agent that works with all of the major companies in your area. The agent can work with you to find the best plan for your situation and budget. They can answer all of your questions and can explain what you get and, more importantly, what you don't get with the policy. There is no extra charge using an agent.
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