Pissed as hell but thankful.

[DSRIGGS]

Scott - since there was an INJURY involved, you may have some other options under both medical AND dental - look at your Evidence of Coverage for both.

As in since it was an injury that medical should kick in? I shall look into this.

Thanks Diana

 

[DianaCox]

This is from my 2014 MEDICAL plan with VA Carefirst BCBS (I need to get an updated copy of my own EoC (Evidence of Coverage), dontcha know?!):

Dental Services
A. Accidental Injury

1. Covered Benefits

Dental benefits will be provided to repair or replace teeth that have been damaged or lost due to injury if the injury did not arise while or as a result of biting or chewing, and treatment is commenced within six months of the injury or, if due to the nature of the injury, treatment could not being within six months of the injury, treatment begins within six months of the earliest date that it would be medically appropriate to begin such treatment.​

2. Conditions and Limitations

Benefits are limited to restoration of the tooth or teeth or the initial placement of a bridge or denture to replace the tooth or teeth injured or lost as a direct and sole result of the accidental bodily injury. Except as listed above ... (blah blah blah)
​

You need to find out what YOUR plan says, of course.

 

[DSRIGGS]

My wife is talking with her HR lady to get the documentation. Thanks!

 

[DianaCox]

Crap, I meant EoC (Evidence of Coverage).

 

[DSRIGGS]

Crap, I meant EoC (Evidence of Coverage).

We found language very similar to yours in her benefit guide. Medical should cover

 

[DianaCox]

Now, find out how to coordinate your medical and dental benefits to make sure he gets a GOOD restoration, implants if possible, or at least good looking zirconium crown (strong and pretty).

 

[DSRIGGS]

Now, find out how to coordinate your medical and dental benefits to make sure he gets a GOOD restoration, implants if possible, or at least good looking zirconium crown (strong and pretty).

He had root canals with the best endodontist in the area two weeks ago and was actually supposed to start the crown work yesterday, but the Dentist was unable to come to work yesterday so it was pushed to this coming Tuesday.

 

[DianaCox]

You may have to document the injury - if you report that he was assaulted, I'd bet the insurance company is going to ask for a police report. Keep in mind that the dentist may have already documented what your son said to him.

 

[DSRIGGS]

I just talked to BCBS and they said they will cover the root canal at the endo and the crowns at the dentist.....of course who knows at what level. The endo already submitted to Delta Dental so hopefully between the two it covers most. He basically told the endo he fell and broke them off. Thanks again for prompting me to check on this. I owe you a dinner!