June 10, 2013
Insurance Company: MetLife
Coverage Type: Health Insurance
- Claim Handling - Denial of Claim
I have had Metlife Dental for as long as the University has had dental insurance, but I never used it until recently. After having a bad dental experience, I went to three different dentists to figure out who to go to. All three agreed on the treatment of one tooth, but there was a wide difference of opinion on the other troublesome teeth, so I went to Tufts Dental School to eliminate the conflict of interest I felt I was experiencing. They took out the broken tooth that all other three dentists agreed on, and started procedures for an implant, what all three other dentists recommended--and all the team who oversee the Tufts dental students. Metlife's in house dentist denys the procedure was necessary and won't pay the claim! Where did he get his degree??? I have just drafted a letter to them, and will send it to the MA Insurance Commissioner. What else can be done?
June 18, 2013 at 7:22 PM
Sandra, You have taken the right first step. Let the IC intervene on your behalf and see if that resolves the issue. Beyond that you can appeal the "in house dentist's" decision with MetLife directly.