How can I successfully appeal an HMO dental insurance denial for anesthesia reimbursement?

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  • #105158 Reply
    Kathleen

      I’d say this portion should be considered as medical and paid by your health insurance.

      I’d push the dentist to file it correctly with your health insurance and delta dental too.

      Tell then you want to see the approvals / denials to make sure you aren’t going to be stuck with it.

      #105159 Reply
      Adriana

        The dentist and physician need to write letters why anesthesia is necessary. Not a guarantee.

        #105160 Reply
        Jane

          If anesthesia is involved then I assume it’s oral surgery & not sedation dentistry.

          Does your health insurance cover it & at a better cost to you?

          We are in a similar situation rn.

          We can run it through my dental or my health insurance because it’s classified as oral surgery.

          #105161 Reply
          Nancy

            Sorry! I have to be some level of sedated for every dental procedure and have to pay for it out of pocket!

            #105162 Reply
            Mimi

              You can try and have the dentist write a letter to your insurance, explaining why this is needed.

              If it is something which is covered by your insurance, and they deny it, you can grieve the decision.

              They might at least pay part of it.

              Unfortunately anesthesia is often an out of pocket expense for dental work.

              Is this a trusted dentist?

              Or can you get a second opinion?

              #105163 Reply
              Kelly

                I’m no help. I’ve undergone dental work when my dentist recommended sedation but I had to forgo it because I couldn’t afford it.

                #105164 Reply
                Karen

                  Quite a while ago , I had a dental procedure and if they did it in the hospital, I could use my medical insurance instead of dental insurance and it was covered.

                  Not sure if your situation

                  #105165 Reply
                  Kristen

                    My daughter cannot have nitrous due to a medical condition. It was medically necessary to have her wisdom teeth removed in the hospital.

                    The oral surgeon wrote a letter for approval by the medical ins.

                    We paid zero since her deductible was already paid.

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