Bone grafting insurance claim issues

NAD. I have Anthem and if I search for in-network dentists from the insurance website there are only oral surgeons listed for in my area and not general dentists.

I only did a little bit of research about this but it seems that insurance really screws dentist offices, so many of them will submit their rates to insurance but then patients owe the remainder of what insurance doesn't cover and they don't offer themselves as in-network care.

I found a dentist I liked and just made sure they'd accept my insurance and they do, that was good enough for me.

Unfortunately, as others have said, it's up to the patient to know what their insurance does and doesn't cover. Offices see hundreds of patients and it'd be impossible to know exactly what each person's individual plan covers. My dentist actually made me sign a form stating it's my responsibility!

When I had an extraction and bone graft last year, the office told me insurance pretty much never covers the graft (I'm assuming because dental implants can be considered cosmetic..silly but whatever!). So I paid for it up front ($580 I believe) and then they submitted the whole bill to insurance and sure enough, not covered at all. They did pay for a portion of the extraction though because the tooth was infected and that IS a necessary procedure.

My dental implant is also not covered, so that's $1900 I owe. But hey, my cleanings each year are free! :p

You can try contacting your insurance to appeal the denied claim.. but I bet if you read your explanation of benefits it will say something about no coverage on bone grafts/implants. Insurance stuff is really confusing though. & "luxury bone" insurance is notoriously bad for most people. I have okay dental insurance and have still paid about $4k for care over the past 12 months.

I would also recommend asking your dentist to send for a predetermination in the future. It's essentially a mockup bill that they send to insurance that would give you an estimate of what coverage you would receive on work BEFORE you get it done!

/r/askdentists Thread