The Dentist Recommended Treatment That My Plan Will Not Pay For. Does This Mean The Treatment Really Isn’t Necessary?
The answer, absolutely NOT!! The most important thing to remember when dealing with insurance companies is that they are “for profit” companies. Saying no to you keeps more money in their pocket. Your doctor recommends treatment based on his/her years of education and experience and your over all health. The most common denial is for composite (white) fillings. A majority of the insurance companies down code the posterior fillings to amalgam (silver) fillings. Why? Composite is up to 25% more expensive and the policy of the insurance companies is to cover the cost of the least expensive restoration. However, there are potential adverse effects of silver fillings which are close to 50% mercury and a mixture of silver-tin alloy and copper. Recent research shows that these fillings release mercury vapor during chewing. Another often denied but necessary procedure is a crown build up. A material is placed in the tooth preparation for a crown when there is insufficient tooth strength and retention for the crown procedure. In layman’s terms, it’s like placing rebar in a foundation. Without the build up a large percentage of the crowns will fail and under the replacement clause of the policy, the insurance company will deny the new crown. There are many additional procedures with exclusions that we deal with on a daily basis. We can help you by submitting a preauthorization to your carrier prior to treatment or help you with an appeal should they deny the claim after. We work hard to be well versed in the major insurance companies so we can advise you of the limitations in advance so you and your doctor can make well-informed decisions. Call us today at (775) 883-7244. We look forward to smiling with you!