Any dentists or insurance experts here?

#26
#26
Ie: to apply a retainer, to apply sedative to insert spacers, to apply local numbing agent to adhere brackets, ect ect
 
#27
#27
The Insurance company is claiming that because the retainers weren't a part of an orthodontic plan, they aren't covered.
 
#28
#28
TXA&M07 said:
You're reading appliance as a noun. It's a verb in this situation. Insurance legal jargon is not always what it seems.
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You serious??? My word, it's a wonder any insured pts have reimbursement for procedures and services if the language is that parsed. Looks to me like active is the verb.

Btw, my son used some of your chicken advice. His layers are doing well. Getting about a dozen per day.
 
#29
#29
CanadianVol said:
The Insurance company is claiming that because the retainers weren't a part of an orthodontic plan, they aren't covered.
Click to expand...

Orthodontic work is typically concluded with a variation of a retainer; permanent or removable. I can't imagine an orthodontic plan in place that excludes that at the end. Hell, I had one.

The insurance company seems to be stonewalling you at this point. Consult with the orthodontic provider and obtain a copy of the procedural plan from start to finish. Sorry if I sound like I'm assigning homework. Just tryin to walk through this with you. Happy to give you some advice provided we get all the details.
 
#30
#30
McDad said:
You serious??? My word, it's a wonder any insured pts have reimbursement for procedures and services if the language is that parsed. Looks to me like active is the verb.

Btw, my son used some of your chicken advice. His layers are doing well. Getting about a dozen per day.
Click to expand...

Love to hear this. So happy that y'all are enjoying chickens as much as I do. Please keep me posted & if you need anything just holler.
 
#31
#31
TXA&M07 said:
Orthodontic work is typically concluded with a variation of a retainer; permanent or removable. I can't imagine an orthodontic plan in place that excludes that at the end. Hell, I had one.

The insurance company seems to be stonewalling you at this point. Consult with the orthodontic provider and obtain a copy of the procedural plan from start to finish. Sorry if I sound like I'm assigning homework. Just tryin to walk through this with you. Happy to give you some advice provided we get all the details.
Click to expand...

I'll talk to them....if they'll talk to me after I went off on them yesterday :) The insurance company is reviewing it, and told me they would let me know in a week, so I may wait until then to contact the orthodontist. I'd be shocked if there was a plan, and if there was, I'm sure it wasn't submitted to Met-Life. She had braces years ago when she was under her parents plan. I just don't understand how this makes any sense. If a dentist recommends it to keep her teeth straight, how is it not orthodontic procedures? Stupid
 
#32
#32
Well let me know if you have any more details or need any help.

Sorry to be long winded sometimes, and to any Alabama fans reading this, "orthodontics" is a fancy word for what y'all call "tooth fixin". HTH.
 
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#33
#33
CanadianVol said:
Out policy says it covers 50% of orthodontics. Just a blanket grouping. When I called they said they only cover retainers after braces, not just retainers. I think I'm getting screwed, but don't know how to resolve this reasonably. I feel like the orthodontist office shouldn't have told me it would be covered if they didn't know. They claim it was "just a quote".
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Tell them to send you a copy of your policy language.
 
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