I have had this insurance for many years. This past January I had some pain in my back teeth from clenching. The dentist on my plan, Dental Associates of Cape Coral, did no x-rays but gave me pain medication. This continued for weeks until they gave me a written referral to see Dr. Larry Dunford for work.
Despite the written referral from my plan dentist, this insurance company refuses to cover this cost saying in letters that I did not receive pre-authorization. In the past month, they have tried to change their story that this was not a covered procedure - it was not cosmetic.
This dentist ruined my teeth and resulted in me having to have 2 teeth extracted and a bridge installed. The bridge installed by Dr. Jeffrey Rubin is too large and has ruined my teeth by not allowing my mouth to close and literally fracturing and shattering my top teeth.
Total loss for the past 11 months? $11,000 out of pocket, 10 teeth, and a cost of over $26,000 to repair the damage.
This insurance company has refused to pay for anything. At one point the Florida Department of Insurance was involved at which time the insurance company agreed for me to see an independent dentist for an evaluation of damage. This was the $26,000 evaluation. As soon as the Fl Dept of Insurance dropped the complaint, the insurance company retracted the agreement and said they would pay for nothing.
This past month an article ran in the region's news paper on my situation (see www.news-press.com, columnist - Sam Cook). The School District in which I am employed got involved and they arranged a conference call for a resolution. The insurance company attacked me with claims that I had eroded teeth and that I caused the damage - I countered with proof from dentists that I had no damage to my teeth from erosion or from the clenching. They stated that they only believe dentists in their network.
I have proof that at one point they instructed a dentist on my plan NOT TO SEE ME and not to make any examination of the bridge in question.
They then tried to say I could see any independent dentist AS LONG AS THE DENTIST IS ON THEIR PLAN. They then changed this to include a dentist at the univeristy - IF THEY COULD CONTACT THEM PRIOR TO THE EVALUATION.
This company is a total scam - taking out my insurance payment with each paycheck throughout the year. They and their dentists who have settled many lawsuits and have been found negligent by the State Board of Health, have ruined me financially and with the loss of my healthy teeth.
I have filed many grievances through out this process and they have NEVER found in my favor for anything - ignoring the many evaluations done by many other dentists.
Thank goodness for this format to warn others. Watch for my story on NBC's Dateline!
Cape Coral, Florida