Delta Dental not covering bone graft

Hello, guys

I need an extraction and an implant in New York. I can travel to the states surrounding New York City.

The dental provider informed me that Delta Dental does not cover bone grafts, thus I will have to pay around $750 out of pocket for the graft, plus 25% for extraction and 50% for the implant.

Is there a way around it? For example, you could file an appeal, or a lawsuit, or ask your dentist to demonstrate why the graft is necessary.

Thanks

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Im a dentist … Unfortunately, filing an appeal or having the dentist write a narrative will not help because your insurance plan does not cover a bone graft. The insurance plan you selected additionally covers 50% of the implant (I have never seen an insurance plan cover more).

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Dental insurance will never cover 100% of restorative work unless you are on state aid, and your benefits will be capped at roughly $1500-2000, so bear that in mind. The implant alone will most likely wipe off your coverage for the year.

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I have seen a Mutual of Omaha plan that covers implants completely, as well as some self-funded dental plans with Ameritas, but it is quite rare, requires an additional rider, and is pricey.

Lurking is correct: if your dental coverage specifically prohibits anything, there will be no β€œappeal” in your favour.

To potentially reduce costs, you can file an appeal with Delta Dental, providing documentation of medical necessity. Ask your dentist to submit a letter explaining the need for the bone graft. Consider getting a second opinion or exploring alternative providers. Dental schools might offer lower-cost options.