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
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).
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.
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 “appeal” 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.