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2014-07-18 11:55 AM

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Subject: Anyone with experience in insurance claims and teeth?

Long story short, crashed the bike a month ago and am now looking at one dental implant and three crowns, possibly a veneer. Bike crash was a solo endeavor that put me over the bars. Needless to say the dental repair is not going to be cheap and dental insurance does not cover much at all. 

Just curious if anyone has been through something similar and had any tips for possibly getting some coverage from medical/homeowner's/rental insurance? I'm about to start the process of phone calls but thought it might be beneficial to see if there was any advice floating around first. 

Thanks in advance. 



2014-07-18 12:45 PM
in reply to: thebigb

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Subject: RE: Anyone with experience in insurance claims and teeth?

 

Unfortunately your homeowners or renters insurance policy is not going to do anything for you in this situation. The small amount of medical payments coverage typically found on these policies is meant for guests at your home that are hurt due to no negligence of yours. Essentially if Grandma trips and sprains her ankle you can offer the medical payments coverage to help her out without admitting any fault on your part. That coverage does not apply to the insured or to permanent members of the household.

 

Good news is, there is a chance your auto insurance may help you out. It really depends on the company and your contract language, but some companies will pay out auto medical payments when you are hurt as a driver/passenger in a vehicle or when you are hurt on the road as a pedestrian. It is very iffy though, I believe my own policy requires me to be hit by a car for the coverage to apply. So if a car had caused your crash it would apply. Cyclists are typically considered pedestrians in contract language. I bumped my coverage to the max of $25k so if I get run off the road and crash I will get some help with medical bills.

As I recall your wreck did not involve a vehicle so the coverage likely won't apply. However if you get the right adjuster on a good day, anything is possible. Definitely worth a phone call but don't be surprised if they shut you down. 

Other than that there are no standard coverages that would typically apply. However check with your company, different companies offer different "bonus coverages" in their packages, there might be something in there that will give you a few $$s. Good luck!

2014-07-18 12:48 PM
in reply to: Aarondb4

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Subject: RE: Anyone with experience in insurance claims and teeth?

I would sue McDonald's.

2014-07-18 1:01 PM
in reply to: Left Brain

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by Left Brain

I would sue McDonald's.

I'm sure somehow this could work.

 

Thanks Aaron, that's what I was hunting for. Yes it was a solo affair with no car involvement but I've already learned that I would have been much better covered if it had involved a car. Still cracks me up (ha) that medical won't even cover teeth in a situation like an accident. Broken arm, fractured skull, paralysis; sure we'll cover it. Teeth; you're on your own buddy. 

2014-07-18 1:17 PM
in reply to: thebigb

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Subject: RE: Anyone with experience in insurance claims and teeth?

Dental insurance is really, really picky about any work on your front teeth, especially veneers.  If you have any documentation of your original injury (clinic visit, initial evaluation, paramedic or police report if they were involved) -- then get it together and send it over to the insurance.  I think with mine they covered like 50%.  But they'll try to give you the run-around claiming that front teeth issues are "cosmetic".  You'll have to be very persistent.

2014-07-18 3:24 PM
in reply to: spudone

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by spudone

Dental insurance is really, really picky about any work on your front teeth, especially veneers.  If you have any documentation of your original injury (clinic visit, initial evaluation, paramedic or police report if they were involved) -- then get it together and send it over to the insurance.  I think with mine they covered like 50%.  But they'll try to give you the run-around claiming that front teeth issues are "cosmetic".  You'll have to be very persistent.

 

What was your incident? Was it dental or medical insurance that ended up covering half?

So far everyone is steering me to medical as being the only possible avenue that might assist. As I expected, auto and homeowner's was a strike out. 



2014-07-18 3:41 PM
in reply to: thebigb

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Subject: RE: Anyone with experience in insurance claims and teeth?

There are other options:

 

 





(newteeth.jpg)



Attachments
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newteeth.jpg (3KB - 2 downloads)
2014-07-18 3:49 PM
in reply to: Left Brain

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Subject: RE: Anyone with experience in insurance claims and teeth?

I was considering Ipe

2014-07-18 3:50 PM
in reply to: 0

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by thebigb

Originally posted by spudone

Dental insurance is really, really picky about any work on your front teeth, especially veneers.  If you have any documentation of your original injury (clinic visit, initial evaluation, paramedic or police report if they were involved) -- then get it together and send it over to the insurance.  I think with mine they covered like 50%.  But they'll try to give you the run-around claiming that front teeth issues are "cosmetic".  You'll have to be very persistent.

 

What was your incident? Was it dental or medical insurance that ended up covering half?

So far everyone is steering me to medical as being the only possible avenue that might assist. As I expected, auto and homeowner's was a strike out. 

Slipped on ice and fell, caught myself on my hands, but got no traction there either, so my face was the next stop.  Dental was the 50% although it was declined on one attempt, then went through on a different try, probably with a different person on the line.  Also I should note that the root in one tooth was damaged and required a root canal, so that was probably helpful getting them away from the cosmetic label.



Edited by spudone 2014-07-18 3:53 PM
2014-07-18 4:17 PM
in reply to: spudone

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by spudone

Originally posted by thebigb

Originally posted by spudone

Dental insurance is really, really picky about any work on your front teeth, especially veneers.  If you have any documentation of your original injury (clinic visit, initial evaluation, paramedic or police report if they were involved) -- then get it together and send it over to the insurance.  I think with mine they covered like 50%.  But they'll try to give you the run-around claiming that front teeth issues are "cosmetic".  You'll have to be very persistent.

 

What was your incident? Was it dental or medical insurance that ended up covering half?

So far everyone is steering me to medical as being the only possible avenue that might assist. As I expected, auto and homeowner's was a strike out. 

Slipped on ice and fell, caught myself on my hands, but got no traction there either, so my face was the next stop.  Dental was the 50% although it was declined on one attempt, then went through on a different try, probably with a different person on the line.  Also I should note that the root in one tooth was damaged and required a root canal, so that was probably helpful getting them away from the cosmetic label.

Pesky ice.

Still may need a root canal. Waiting a month or two before moving forward to see if that's going to be necessary or not. 

2014-07-18 4:33 PM
in reply to: Left Brain

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Subject: RE: Anyone with experience in insurance claims and teeth?
Originally posted by Left Brain

There are other options:

 

 




That's what his teeth looked like before the fall.


2014-07-18 5:02 PM
in reply to: thebigb

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by thebigb

Originally posted by spudone

Originally posted by thebigb

Originally posted by spudone

Dental insurance is really, really picky about any work on your front teeth, especially veneers.  If you have any documentation of your original injury (clinic visit, initial evaluation, paramedic or police report if they were involved) -- then get it together and send it over to the insurance.  I think with mine they covered like 50%.  But they'll try to give you the run-around claiming that front teeth issues are "cosmetic".  You'll have to be very persistent.

 

What was your incident? Was it dental or medical insurance that ended up covering half?

So far everyone is steering me to medical as being the only possible avenue that might assist. As I expected, auto and homeowner's was a strike out. 

Slipped on ice and fell, caught myself on my hands, but got no traction there either, so my face was the next stop.  Dental was the 50% although it was declined on one attempt, then went through on a different try, probably with a different person on the line.  Also I should note that the root in one tooth was damaged and required a root canal, so that was probably helpful getting them away from the cosmetic label.

Pesky ice.

Still may need a root canal. Waiting a month or two before moving forward to see if that's going to be necessary or not. 

Also talk to your dentist and have his office deal with your insurance.  Tell your dentist you want him to try and get a pre-approval from insurance for the work you need.  It takes a few weeks but they are usually more persuasive than you can be on your own.  Plus your dentist is financially motivated to make it happen.

2014-07-18 5:10 PM
in reply to: spudone

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Subject: RE: Anyone with experience in insurance claims and teeth?

Hey bigb -  count your blessings, always someone worse, right?  I watched a 17 year old girl faceplant last weekend.........lost 3 cracked 3.....brutal.

Good luck!! I hope it works out.

2014-07-18 5:13 PM
in reply to: Left Brain

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by Left Brain

Hey bigb -  count your blessings, always someone worse, right?  I watched a 17 year old girl faceplant last weekend.........lost 3 cracked 3.....brutal.

Good luck!! I hope it works out.

Oh absolutely! I'm not one to wallow in self pity. Hell, I'll probably have a better smile anyway once this is all done.

2014-07-18 5:18 PM
in reply to: thebigb

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by thebigb

Originally posted by Left Brain

Hey bigb -  count your blessings, always someone worse, right?  I watched a 17 year old girl faceplant last weekend.........lost 3 cracked 3.....brutal.

Good luck!! I hope it works out.

Oh absolutely! I'm not one to wallow in self pity. Hell, I'll probably have a better smile anyway once this is all done.

Yeah, that's why I knew I could have some fun with you.  I got to this girl, she was pretty banged up from head to toe with road rash, and bleeding out of her mouth....I said, "smile at me" so I could see where the blood was coming from.......then I said, "doesn't look too bad".  Damn, I felt bad for her.  She was a trooper.....bandaged up and went to awards ceremony.  Pretty cool.

2014-07-18 5:27 PM
in reply to: Left Brain

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by Left Brain

Originally posted by thebigb

Originally posted by Left Brain

Hey bigb -  count your blessings, always someone worse, right?  I watched a 17 year old girl faceplant last weekend.........lost 3 cracked 3.....brutal.

Good luck!! I hope it works out.

Oh absolutely! I'm not one to wallow in self pity. Hell, I'll probably have a better smile anyway once this is all done.

Yeah, that's why I knew I could have some fun with you.  I got to this girl, she was pretty banged up from head to toe with road rash, and bleeding out of her mouth....I said, "smile at me" so I could see where the blood was coming from.......then I said, "doesn't look too bad".  Damn, I felt bad for her.  She was a trooper.....bandaged up and went to awards ceremony.  Pretty cool.

Like a boss! 



2014-07-20 11:08 PM
in reply to: thebigb

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by thebigb

Long story short, crashed the bike a month ago and am now looking at one dental implant and three crowns, possibly a veneer. Bike crash was a solo endeavor that put me over the bars. Needless to say the dental repair is not going to be cheap and dental insurance does not cover much at all. 

Just curious if anyone has been through something similar and had any tips for possibly getting some coverage from medical/homeowner's/rental insurance? I'm about to start the process of phone calls but thought it might be beneficial to see if there was any advice floating around first. 

Thanks in advance. 

 

Look to your auto insurance for "medical payments". Most people have some on their policy, usually $1,000 is a minimum., you can carry larger amounts it''s inexpensive and covers a lot. If you have a good agent he should be able to help guide you through the process. If not call the claims department. 

It's cheap relatively speaking, find out the maximum you can add and find out the price. 

2014-07-20 11:12 PM
in reply to: Aarondb4

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by Aarondb4

 

Unfortunately your homeowners or renters insurance policy is not going to do anything for you in this situation. The small amount of medical payments coverage typically found on these policies is meant for guests at your home that are hurt due to no negligence of yours. Essentially if Grandma trips and sprains her ankle you can offer the medical payments coverage to help her out without admitting any fault on your part. That coverage does not apply to the insured or to permanent members of the household.

 

Good news is, there is a chance your auto insurance may help you out. It really depends on the company and your contract language, but some companies will pay out auto medical payments when you are hurt as a driver/passenger in a vehicle or when you are hurt on the road as a pedestrian. It is very iffy though, I believe my own policy requires me to be hit by a car for the coverage to apply. So if a car had caused your crash it would apply. Cyclists are typically considered pedestrians in contract language. I bumped my coverage to the max of $25k so if I get run off the road and crash I will get some help with medical bills.

As I recall your wreck did not involve a vehicle so the coverage likely won't apply. However if you get the right adjuster on a good day, anything is possible. Definitely worth a phone call but don't be surprised if they shut you down. 

Other than that there are no standard coverages that would typically apply. However check with your company, different companies offer different "bonus coverages" in their packages, there might be something in there that will give you a few $$s. Good luck!

I'm not positive but if you are struck by another motorist and it is a hit and run, I believe your Un-insured/Under-insured motorists coverage would respond.

You could be right about a "motor" vehicle needing to be involved for the Med Pay to respond. 

2014-07-24 5:43 PM
in reply to: spudone

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Subject: RE: Anyone with experience in insurance claims and teeth?

Starting to bang my head against the wall. Talked to insurance (Cigna) and explained the situation. Their response was "yes, that will fall under medical because it was an accident" and provided me with a list of oral surgeons that are in network and I can see. Every single one of them has been a bust. Most of them only work with Medical claims for apnea or other (non teeth) issues or the only medical billing they do in network is for emergency trauma at the hospital itself. So I can get coverage but I can't find anyone that will actually do the freaking work!

2014-07-25 7:34 AM
in reply to: thebigb

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Subject: RE: Anyone with experience in insurance claims and teeth?
did you get it in writing from them that it is covered?
2014-07-25 9:42 AM
in reply to: thebigb

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by thebigb

Starting to bang my head against the wall. Talked to insurance (Cigna) and explained the situation. Their response was "yes, that will fall under medical because it was an accident" and provided me with a list of oral surgeons that are in network and I can see. Every single one of them has been a bust. Most of them only work with Medical claims for apnea or other (non teeth) issues or the only medical billing they do in network is for emergency trauma at the hospital itself. So I can get coverage but I can't find anyone that will actually do the freaking work!

If insurance will cover it can you pay for it and get it reimbursed from your insurance company?



2014-07-25 11:54 AM
in reply to: ajusf16

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Subject: RE: Anyone with experience in insurance claims and teeth?

Originally posted by ajusf16 did you get it in writing from them that it is covered?

It actually is detailed in my policy, they showed exactly where to me.

 

As far as reimbursement- no clue but I highly doubt it since I'm working with an HMO here. (as an aside, I had a great PPO up until this year) But my next call I make will certainly include an inquiry to this. 

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