Pediatric Dental Being Denied?
I have a health insurance (UHC) plan through a large employer. UHC is attempting to not cover my son’s sugery room and Anesthesia for a proceedure done to fix his teeth. He received 3 crowns and 5 fillings and since he is 2 years old they preformed it in a surgery center at a Children’s hospital. The medical insurance is denying the surgery center and Anesthesia on the grounds it is related to teeth. The dental insurance does not cover surgery centers and I believe Anesthesia. I know Pediatric care is an important part of the Essential Health Benefits. Please point me to a law, which would support my believe: Medical Insurance is required to cover this on a minor.. because it is part of the EHBs.
Answer
Dental insurance is required for minors, however dental insurance doesn't work the same way as health insurance. With health insurance under the ACA your insurer pays 100% after you reach the maximum. On a dental plan, the insurer pays zero after you reach the maximum.
This being said, you should be covered by a dental plan up to that plans maximum, so if you took the dental coverage with your insurance and the dental part of the plan is denying the claim you can appeal. You can also appeal the decision in general on the grounds that it was essential medical surgery. You have the right to an appeal, although your insurer may be technically in the right.
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I have ran into the same issue. Our Health insurance should be covering my 3 year olds Anasthesia and surgery room, but on the other hand my dental plan I pay for out side of our health insurance only covers up to $1000 dollars so therefore, for a medically necessary dental procedure we are to pay over $3,500 dollars out of pocket. We used the pediatric dentist in our area that was on our UHC health insurance “Preventive Care” but That dentist made his mouth worse now costing more to fix child’s teeth issues. So either way “Preventive Care” on UHC dentist are terrible and separate dental insurance doesn’t help due to the maximum.