Dental Procedure Denial: Medical Necessities Should be Covered Switch to ADA Accessible Theme
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Medical Necessity and Dental Procedures

Advanced Medicine, Trusted Care. Attractive woman at the dental office. Dentist examining patient's teeth in clinic.

Anyone who has had a serious dental problem knows that oral health can absolutely affect your overall health. If you don’t have dental insurance, a dental or orthodontic procedure can be prohibitively expensive. Under certain circumstances, however, you may be able to get your dental procedures covered under your general health insurance plan. If your dental procedure was wrongfully denied coverage by your health insurance company, you might even have a claim for insurance bad faith. Read on to learn about health insurance coverage of dental procedures, and call a savvy Los Angeles health insurance benefits denial lawyer for assistance obtaining insurance coverage in southern California.

Medically Necessary Procedures Should be Covered, Even if They Are Dental

Medical insurance is meant to cover any treatments necessary to treat a diagnosed medical condition. Whether that treatment occurs in a dental office is beside the point. There are any number of diagnosable medical conditions that can affect the dental region. A patient requiring dental surgery to recover after a traumatic accident, for example, is obtaining medical care. A diagnosed gum inflammation, infection, or disease is a medical condition that requires medical care to fix. Treatments necessary to alleviate sleep apnea, chronic facial pain, or headaches may also be medical. X-rays and other imaging necessary to diagnose a medical condition may also be covered.

Generally, diagnostic procedures for identifying medical conditions, non-surgical medical treatments for diagnosed medical conditions, surgical treatments for most things (unless purely cosmetic), biopsies, and treatment for traumatic injuries should all be covered by medical insurance based on the terms of the policies. Preventative dental care such as teeth cleaning, on the other hand, is not a necessary treatment for medical conditions. For those procedures, dental insurance or paying out of pocket is still required. If you have an insurance claim denied for a dental condition, talk to an insurance coverage attorney to find out if your health insurance should cover your treatment.

Dental Procedure Denial and Bad Faith

Health insurance companies are required to interpret their policies and medical evidence in good faith. The fact that you are seeking surgery in your mouth as opposed to on other parts of your body does not absolve your health insurance company of their duty to provide coverage where appropriate. If your health insurer tries to issue a blanket denial of your necessary surgery just because it falls under the ambit of dental, they may be engaging in insurance bad faith. Insurers can be held liable for bad faith claim denials and other wrongful conduct, and you may be able to recover additional damages on top of the benefits you are owed. A knowledgeable bad faith insurance attorney can evaluate your claims and help you understand your rights.

Trusted Advice and Representation for Recovering Health Insurance Benefits in California

If your health insurance claim has been unreasonably denied, or if you are facing other bad faith insurance issues in California, fight for the coverage you are owed with the help of the dedicated, veteran Los Angeles insurance claim denial lawyers at Gianelli & Morris. Call for a free consultation at 213-489-1600.

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