General anesthesia...not a medical necessity?!?

Question

My 10 yro daughter had 8 teeth removed at the oral surgeon's last month. This was a necessity as there simply is not enough room for all of her teeth. Of those 8 teeth, 4 were baby teeth and 4 were adult, one of which was bony-impacted and required surgery.


Because we are "out of network" the oral surgeon required us to pay up front for his services, so we paid $1,700, $450 of which was for general anesthesia.


Imagine our shock and disgust when we learned that Cigna will not cover general anesthesia for oral surgery unless there are TWO bony-impacted teeth or more to be removed! The surgeon's office has appealed to the medical portion of our plan as well as urging and RE-URGING Cigna to reconsider, but they're firm and they've denied the claim twice. These retards actually see no reason why a 10 year old child would need general anesthesia while surgery is being performed in her mouth!

So, here's my question. Is it even worth it to have a letter of medical necessity prepared and to go through the formal appeals process? Do this ever work for anyone when a claim is denied?

Note to Kevin R: Be a dear won't you, and blow me?

My husband and I pay dearly for Cigna health and dental, peckerhead and no, we don't expect them to pay for everything, but we do, at the very least, question an insurance company's determination that general anesthesia is necessary for TWO bony impacted extractions, and not ONE. Our oral surgeon had, until now, never heard of such a thing.

Of course I only recall asking if an appeal was worth it. I honestly can't remember asking you for a soliloquy aimed at us pesky health care policy holders.

Good grief, get a grip on yourself.

Answer 1

It's worth it to appeal because many patient appeals win. Besides, YOU'RE the one PAYING Cigna, so they usually do back down to the patients if medical necessity can be proven.

It's going to be frustrating, and insurance companies bank on p*ssing you off so you back down and just pay it. Appeal it as far as you can - more often than not, if they see you're holding your ground, they back down.

Good luck!

Answer 2

Yes, you should appeal! Cigna has an internal appeals process for medical claims that have been denied. It may take a while to get an answer from them, however.

If you're still denied (that's absolutely ridiculous, my God she's a 10 year old girl having 8 teeth pulled, for crying out loud, how inhumane can they be?!!) then you can contact your state's Banking and Insurance Division with your claim. They can often start an independent review process for you and can and very often DO intervene in these matters.

Good luck to you!

Wow...Kevin! Only on Yahoo! Answers one day and reported already! Great job, trashmouth. You kiss your mother with those lips?

Answer 3

Before the surgery, did the dentist try to
get a pre-approval for the general anesthesia. ??

Quite often an ins co will give consideration to what it necessary if you ask their approval BEFORE the procedure,

Too late now.

Answer 4

Yes, it works about half the time. DEFINATELY worth the $.39.