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  1. #1
    Join Date
    Apr 2012
    Posts
    5

    Default Dental Insurance Denial

    My question involves insurance law for the state of: New Jersey

    I have Aetna PPO Plan with UPS... And the dental insurance has denied my claim even though it's unlimitted coverage on dental.. It did however approve for one doctor on implants way back, but I had peridontic work on my gums and the new doctor notice it needs bone graphic and other dental work needed to be done to maintain a healthy gum to hold the implants.. The new doctor send in an appeal to have certain work approve so that the doctor could achieve his work successfully... If the insurance had approve implants for other patients and denied my claim even though I'm a member with them throught UPS.. Can I sued them for medical malpractice or insurance malpractice for denying my rights to get dental work while I'm still paying them out of my pocket every week??

  2. #2
    Join Date
    Jan 2008
    Location
    Toledo, OH
    Posts
    16,307

    Default Re: Dental Insurance

    Did you appeal the denial?

  3. #3
    Join Date
    Apr 2012
    Posts
    5

    Default Re: Dental Insurance

    Yes I have and the decision will be made by May 7th.. I believe this Monday coming.. I know I'm ahead of this but I want to make sure to see if I have a legal recourse in the event if this appeal is deny again.. Thank You!

  4. #4
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Dental Insurance

    On what basis was it denied? What reason was given for the denial?

    You most definitely do not have any kind of suit for medical malpractice. That's for when the doctor or dentist screws up, not for when you get an insurance claim denied. More information is needed to determine if you have the basis for any other kind of suit.

  5. #5
    Join Date
    Apr 2007
    Location
    Il.(near StL,Mo.)
    Posts
    5,252

    Default Re: Dental Insurance

    We can't tell you much without knowing the reason for the denial. Maybe your appeal will be approved.

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