Broken Teeth Covered by Medical (Not Dental) Insurance?

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cowdogman
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Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by cowdogman » Mon Jan 13, 2020 9:52 pm

My 22 YO son had a bicycle accident last week (he turned hard to avoid a car that ran a stop sign--and the car kept going) and along with various cuts and scrapes, broke off his two front top teeth. He's been to the endodontist for a root canal and to the dentist (3 times) to start to get his teeth ready for crowns. He will also need orthodontia to pull down the two tooth stubs down a couple millimeters before the crowns can be mounted. We're looking at about 12 months of dental visits and a cost of $9,000 to $10,000 (maybe a little more).

He's fine and it could have been worse, and $10,000 is a fair price for two front (mostly real) teeth. Plus his doctors have been amazing.

My question is whether any of you have had experience dealing with medical insurance companies on broken teeth caused by accidents.

I read my son's health insurance policy (through his college) and it expressly covers treatment for damage to healthy teeth caused by accident performed by a "licensed practitioner of the healing arts," which I believe includes dentists. So, I think he has a claim.

BTW we looked into implants and the clear answer from everybody (including an implant doctor) was "save the teeth." Plus implants are more expensive than what I outlined above--we were quoted $5,000/tooth and 8-12 months to finish.

Also, we're not interested in tracking down the driver and suing him.

Any thoughts/suggestions?

JustMe
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by JustMe » Mon Jan 13, 2020 10:16 pm

Was a police report filed? Without an actual collision between the car and bike it might depend on state law and/or the contents of the police report, but if your son has automobile insurance with uninsured motorist coverage then it might be worth looking into whether that might cover medical and dental costs related to the accident.

AznSaver
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by AznSaver » Mon Jan 13, 2020 10:35 pm

JustMe wrote:
Mon Jan 13, 2020 10:16 pm
Was a police report filed? Without an actual collision between the car and bike it might depend on state law and/or the contents of the police report, but if your son has automobile insurance with uninsured motorist coverage then it might be worth looking into whether that might cover medical and dental costs related to the accident.
+1 , It is possible for uninsured motorist to cover this with a police report under "phantom vehicle coverage".

This situation is a health insurance dental claim, look at the coverage of loss/limits of coverage section in the insurance for clarity on coverage.
Dental insurance typically covers the general health and maintenance of teeth, gums, etc. and not recovery from catastrophe.
(example chipped tooth: dental, punched out teeth: health, although typically both are handled by dentist/specialty dentist)

Vanguard Fan 1367
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by Vanguard Fan 1367 » Mon Jan 13, 2020 10:40 pm

You think he has a claim. I am guessing that the dentists doing the work might be willing to have their dental teams look into the coverage and see what sort of dollars that plan will offer.

Unfortunately usually when you get teeth involved to quote and oral surgeon friend, "they aren't part of the body." So if there is dental coverage the insurance covering the teeth has pretty low maximums compared to the 10 grand or so you are looking at.

bsteiner
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by bsteiner » Mon Jan 13, 2020 10:49 pm

Would no-fault auto insurance or auto insurance medical payments cover it?

toofache32
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by toofache32 » Mon Jan 13, 2020 10:54 pm

One important point to clarify on MEDICAL coverage of dental issues. Your medical insurance might reimburse you for what you pay the dentists, but the financial risk is yours, not the dentist's. Generally the dentists are unwilling to take this financial risk, and for good reason since medical insurance is notorious for looking for a way to not pay, despite what the policy states. Especially since medical insurance says something is "covered" but will not apply a dollar amount to tell you or the dentist what that means.

jbmitt
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by jbmitt » Mon Jan 13, 2020 10:59 pm

It may meet the definition of an auto accident and medical payments coverage could come into play.

123
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by 123 » Mon Jan 13, 2020 11:27 pm

cowdogman wrote:
Mon Jan 13, 2020 9:52 pm
...BTW we looked into implants and the clear answer from everybody (including an implant doctor) was "save the teeth." Plus implants are more expensive than what I outlined above--we were quoted $5,000/tooth and 8-12 months to finish...
+1 He'll always be better off with natural teeth, even if they are heavily repaired/augmented. We've got friends with implants and while most of them are satisfied they are a couple that have "issues". And once you remove a tooth for an implant there's no going back.
The closest helping hand is at the end of your own arm.

TBillT
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by TBillT » Mon Jan 13, 2020 11:58 pm

Once fainted while jogging, knocked out my 2 front teeth.
Believe corporate medical plan did pick up some cost in addition to the dental coverage.
One tooth was gone completely so that's an implant, and the other had just enough left to cap. Really great, strong repair but now after some years the live tooth grew just a bit longer than my bionic tooth. The implant is super strong.

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cowdogman
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Re: Broken Teeth Covered by Medical (Not Dental) Insurance?

Post by cowdogman » Tue Jan 14, 2020 12:44 pm

toofache32 wrote:
Mon Jan 13, 2020 10:54 pm
One important point to clarify on MEDICAL coverage of dental issues. Your medical insurance might reimburse you for what you pay the dentists, but the financial risk is yours, not the dentist's. Generally the dentists are unwilling to take this financial risk, and for good reason since medical insurance is notorious for looking for a way to not pay, despite what the policy states. Especially since medical insurance says something is "covered" but will not apply a dollar amount to tell you or the dentist what that means.
Thanks all.

Yes, the position of the various dental doctors was (1) we should make a health/medical insurance claim and (2) the doctors would help us (in the background) but we were responsible for dealing with the insurance company. Fair enuf.

Very interesting advice about the auto coverage. I will keep that in my back-pocket pending what happens with the health/medical insurance.

Thanks again.

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