Medicare, Medicaid, Life and Health Insurance/Dental claim denied


Hi Tricia,
Hope you can help me with this one.  Last year, I was hospitalized and nearly died from a Diabetes-related condition called "Ketoacidosis."  The extremely high level of acid in my system had many repercussions, one of which was the destruction of tooth enamel, leaving me essentially "toothless."
The consensus of opinion among dental experts is that I would best be served by Implant Retained Dentures, at a cost upwards of $50,000.  The problem is that my health insurance contains a clause specifically denying any dental claims, even if the situation arose as a result of a medical disease.

Under these circumstances, do I have any recourse at all?  For instance, is this something I could challenge through a Consumer Assistance Program?  Is this clause even legal?
Thank you so much for your consideration.

Hi Tina----

Medical insurance does not pay for dental procedures.  They only pay for medical procedures.  

Clauses are in policies are made so that the customer is aware going in on what they pay or what they do not pay for.  It is legal and all insurance companies do that.  They can decide what they will pay for and what not and it is legal as long as there are clauses in writing.

You can perhaps try to persuade them that this is not a dental procedure but a medical however then you would have to find a medical doctor to do procedure since they will not pay for a dentist and I doubt you will be able to find one who can do it.  But if you can you can try to fight them but you probably have a slim chance on getting them to pay.

Good Luck!

Medicare, Medicaid, Life and Health Insurance

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Has your medical insurance company denied your claim and refuses to pay? Have you received a pre-authorization and still your insurance company refuses to pay? How can you get your insurance company to reverse a denied claim? How do you get a provider to waive your copayment if you are financially unable to pay? Can a provider sue you for a unpaid bill and will they? Can a provider send me to a collection agency for a medical bill? If my insurance company does not pay, am I responsible? If you have these questions or others on why your insurance company is not paying your bills, I can help. I can give you "tricks of the trade" to get your insurance company to pay. I have limited knowledge on Medicare and Medicaid and that is not my expertise. Each state is very different regarding Medicare and Medicaid so you need to review their website when you have questions. So please no Medicare or Medicaid questions!!


In the medical field for over 20 years spending majority of time in the collections aspect.

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