[Stephanie]

Regarding trying to get reimbursed from health insurance.
My young son needs substantial dental work and the dentist advised he be under general anesthesia due to how long the procedure will take and how invasive/painful it will.

When submitted to our dental insurance for the pre-authorization the work itself was partially covered but the anesthesia was not and it’s around the neighborhood of $3000.

I called the insurance (DeltacareUSA which I do NOT recommend by the way) and they said because it’s an HMO they will not consider a reimbursement.

Is there a way to appeal that anyone has found successful?

[Kathleen]

I’d say this portion should be considered as medical and paid by your health insurance.

I’d push the dentist to file it correctly with your health insurance and delta dental too.

Tell then you want to see the approvals / denials to make sure you aren’t going to be stuck with it.

[Adriana]

The dentist and physician need to write letters why anesthesia is necessary. Not a guarantee.

[Jane]

If anesthesia is involved then I assume it’s oral surgery & not sedation dentistry.

Does your health insurance cover it & at a better cost to you?

We are in a similar situation rn.

We can run it through my dental or my health insurance because it’s classified as oral surgery.

[Nancy]

Sorry! I have to be some level of sedated for every dental procedure and have to pay for it out of pocket!

[Mimi]

You can try and have the dentist write a letter to your insurance, explaining why this is needed.

If it is something which is covered by your insurance, and they deny it, you can grieve the decision.

They might at least pay part of it.

Unfortunately anesthesia is often an out of pocket expense for dental work.

Is this a trusted dentist?

Or can you get a second opinion?

[Kelly]

I’m no help. I’ve undergone dental work when my dentist recommended sedation but I had to forgo it because I couldn’t afford it.

[Karen]

Quite a while ago , I had a dental procedure and if they did it in the hospital, I could use my medical insurance instead of dental insurance and it was covered.

Not sure if your situation

[Kristen]

My daughter cannot have nitrous due to a medical condition. It was medically necessary to have her wisdom teeth removed in the hospital.

The oral surgeon wrote a letter for approval by the medical ins.

We paid zero since her deductible was already paid.

[Author]

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