At long last… I had my wisdom teeth out back in April and, at the time, Cigna (my dental insurer) refused to cover the extractions. While our dental insurance isn’t great, this was a major disappointment — the oral surgeon’s bill was close to $1300. Had the extractions been covered, our co-pay would have been about half this amount, so… I went ahead and appealed Cigna’s decision. In mid-July, I received the welcome news that they’d changed their mind — they were now willing to cover the extractions. And so began a protracted battle between the oral surgeon’s office, Cigna, and little old me.
Given all of the problems that I had in getting the two on the same page, I have to hand it to Cigna. They were far less problematic than the oral surgeon’s office, who seemed to fight me every step of the way. Anyway, by the time I got: (1) my teeth out, (2) the appeal approved, (3) the oral surgeon to bill Cigna, (4) Cigna to make their payment, and (5) the oral surgeon to apply the payment properly, and to write off the appropriate amounts such that we’d actually get what they owe us, just under seven months had passed! During this time, I made innumerable phone calls and spent countless hours (yes, hours) getting this all straightened out, but… We’re now due a refund of just over $660. Assuming that the check actually shows up in 3-4 weeks as promised, this will soon be a distant (albeit dismal) memory. I can only imagine the number of people that don’t have either the time or the inclination to sort out things like this, and end up getting ripped off in the process.
14 Responses to “On Dental Insurance, Appeals, and Pulling Teeth”
…your appeal to CIGNA sounds reasonable, but it might have been easier to have worked more closely with your dentist — to ensure his billing to the insurance company used the correct medical statements & billing codes.
Hasty or indifferent billing ‘paperwork’ by the healthcare provider can negate insurance payments that you are really entitled to…
My experience seems like a walk in the park compared to yours. I’m still waiting for my refund check, but it’s only been two weeks. I do know how much I’ll be getting and hopefully there will be no surprises…
“it might have been easier to have worked more closely with your dentist”
Actually, this was part of the problem… I worked closely with the oral surgeon’s business office on the appeal and ended up getting a huge runaround — This is why it took from the end of April through early July to get a decision on the appeal. The woman in the business office basically lied to me for two months about having submitted the appeal. When I finally called her on it, she claimed that the appeal had been denied. I then contacted Cigna and they said that they hadn’t yet received an appeal, much less denied it. When I finally got the business offive to submit the appeal, Cigna approved it within about 10 days. My suspicion (although I have no evidence of this) is that the oral surgeon tried to give my appeal the good old ‘desk veto’ because, if approved, they would have to accept a lesser amount for the work. In fact, they ultimately had to write off about $400.
Ouchies! I’m needing to get mine done, and I just signed up with Cigna. Coverage begins in January. Does anyone have any tips on making sure that this doesn’t get denied, what I should ask for, etc? Perhaps get confirmation from Cigna that it’s all approved before the operation?
You may want to rethink dental (and vision) insurance. It’s basically a “trading of dollars” deal where neither you nor the insurer make much. Consider putting the premiums into an HSA and use them when you need them.
My husband had some teeth removed. 2 were normal teeth and the other 2 were wisdom teeth. One wisdom tooth was alreay erupted. When the dental office called to see about coverage they said they would pay at 80%. After the procedure they are denying the claim saying they don’t cover wisdom teeth (oral surgery) Our medical only covers if it was boney impacted and it was not. Then who covers this? what a rip off. I am appealing this and first appeal cigna denied it. I am not stopping there. Now the dentist office is trying to bill me for more than what even the insurance was suppose to pay. any advice anyone has please write to me at LetChocolateflow@aol.com
Welll Cigna is a really bad insurance company my entire familiy has had it for over 4 years and I had to appeal almost every single claim even for a simple examination from a family M.D. Also you have to be absolutely sure of what your insurance will cover. Ask more than once and make sure what you pay out of pocket is definitely covered. Also I was doing some math and I added up how much we had paid in total to the Cigna corporation and subtracted the amount they paid for us. It would have been cheaper if we just paid out of pocket hands down. I would invite that you do the same and see if you are saving any money or just making the board members and CEO of Cigna rich lol
About working with your dentist. Isn’t that the job of the office to A) do the codes correctly and B) fix their own mistakes? I find it rediculous that I’m doing the job of a secretary who is incompentent or doesn’t care.
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