Bone graft and insurance

[Leslie]

My daughter recently had a bone graft done. Our insurance is denying the claim as "dental related". We have Medica. Has anyone had problems or been successful in getting insurance coverage for this procedure, and what do you suggest????
Thanks for any advice!

[Anonymous]

I'm not sure about your insurance but it should at least partly pay for it becuase it's neccessary, correct?

[amy]

Hi, while we've not yet had bone graft surgery, my son did have a palate expander done by an orthodontist and it's coverage was denied by our insurance. I appealed twice and was in contact with the insuance company many times over the phone until they finally told me it was cosmetic and would not be covered. Well I disagreed since obviously in order to align the gum arch for future bone graft surgery it was necessary to expand the palate. Even after explaining that they still denied the claim. The next thing I did was write a letter of complaint to the insuance commisioner in my state. After about 3 weeks waala, a check in the mail for 80% of the cost of the orthodontist bill from the insurance co. From what I've heard they do not want to get a bad name from the state ins. commisioner. And while I would never try to make an insurance cover something they should not be liable for, I believe this was a subject they are obviously not informed or educated on and therefore many claims are being denied. I would encourage you to first take the steps your insuance lies out with the appeal process and include letters from your plastic surgeon and bone surgeon with the appeal. Then keep appealing, if you then exhaust that route I would definately try the insurance commisioner. I just called the office and was told I had to file a complaint and that an employee would be assigned to research and deal with the insuance co. on your behalf. Good luck on this, it is definately something that should be covered. If you need any more help please let me know at kcoon99@yahoo.com

[lena]

Medical insurance must cover a bone graft not dental. That is a medical problem, not directly dental.

[Jessie Walker]

I myself was born with a cleft lip and palate. I am now 22 years old, and have endured 27 surgeries. I have had many problems along the way with insurance not wanting to cover various procedures. To handle this, I had my surgeon write a letter to the insurance company, explaining the necessity of the surgery. This has always worked for me. Normally, when they are brought up to speed on what the surgery is for and why you/your child need it, they don't argue. I hope I have helped you. If you want to reply, my email address is JNaomi228@excite.com.


Thank you.