I pride myself on being on top of our medical expenses. So, my pride was definitely hurt when some recent dental work cost twice what we were expecting. Jay needed a crown. The dentist sent us a “Treatment Case” which included an estimate of the cost. Delta Dental covers 50% and the damage was $476 us, $476 Delta.
Not until the work was done and the paperwork submitted did we discover that the crown was not, in fact, covered. Note 41 on the Explanation of Benefits stated “This service is allowed 1 time in a 5 year period…” It had been 4 years and 3 months since Jay had the original crown on tooth no. 14.
I may be on top of our medical expenses, but I do not keep track of individual teeth.
This is the first time (in my recollection) that our benefits have not covered something. From now on, when it comes to non-preventative work we will be asking our dentist to get a predetermination from the insurance company. This, apparently, takes 4-6 weeks. In this case, Jay was looking at a root canal if he didn’t get the crown attended to. So, we wouldn’t have waited until the 5 years had passed.
But, hopefully, in the future getting predeterminations will show us that we are covered or warn us when we are not going to be covered. That way we can at least make an informed decision vs. getting an unpleasant surprise. Dental work is already unpleasant enough as it is!