Question:
I would like some advice from dentists.
Is it customary for most insurance companies to offer some coverage on crown
replacements after the crowns are five or eight years old?
I recently had cosmetic dentistry done on my front teeth, and Aetna Dental
refused to give me one penny on three crowns that were 20 years old.
I work for a state university in NJ and have better insurance coverage than
most people. Yet, in this instance, my dentist told me that he never had an
insurance company give him such a hard time on crowns that are 20 years old.
I am very unhappy with the way Aetna handles claims. I think they use
deliberate delay tactics. My dentist had to submit the claim and x-rays three
or four times. I appealed their decision and was told I sent it to the wrong
address, even after I called to verify it was the right address. Then they
backpeddled and said either address was fine.
Any similar experiences about Aetna and crown replacement in general is
appreciated.
Answer:
You used the "c" word. Most (all?) dental insurance doesn't cover cosmetic
procedures. There has to be a real, diagnosed problem with the dental work
in order to have it replaced.
That seems to be the case. We recently had a staff meeting and this was one of
the topics. Aetna of all the insurance companies stands outs. It is so bad
that we have started notifying our clients that they have 30 days to make other
financial arrangements and at the point we will no longer be able to accept
assignment of benefits from Aetna. This is the first and only time I have done
something like this in 22 years of practice.
When a company delays paying claims, they obviously know that they get to keep
the money longer and earn interest on it the so called concept of float.
Also, the longer they delay in paying claims the more of the claims that will
be forgetten about and never resubmitted for payment so the insurance company
profits twice.
Finally, patients need to realize that they have often through collective
bargaining taken less in payroll offset by greater benefits. When the
insurance company fails to pay claims, the employee is being stollen from.
Finally, there is a class action lawsuit involving US dentists and Aetna. It
is not on the same topic but that may have something to do with claims
activity.
I wonder if Aenta's current marketing slogan, TURNING PROMISE INTO
PRACTICE, is really an inside joke about their hidden delay tactics
(i.e. we promise the check is in the mail, we didn't get your x-rays,
your dentist didn't provide us with the proper narrative, you must
have sent the forms to the wrong address etc.)
Aetna paid on part of my claims, but as I said, my dentist was
surprised that they turned down crown replacements that were 20 years
old. His office has also experienced other delays with Aenta. I'll
let this group know how my appeal turns out.
