Aetna Dental Insurance

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  • Problem
  • Updated 3 years ago
I had my first upper partial placed in 2009. I have had Aetna dental for many years. They covered the partial in 2009 paying 40% of the total cost. Due to new problems that arose, I needed a new partial in 2013. aetna has a 5 year rule and denied the claim in 2013, so I had to pay for it in full. Now in 2017, I again needed a new partial and the process begun in February. So my dentist submits the claim for the partial ( his office called Aetna prior to this procedure and was told Aetna would pay $650. To my surprise Aetna denied the claim! I went to their website and asked why they declined coverage and was told again about their 5 year rule. I protested and told them to check their records, that the partial in 2013 was paid in full by me. I got this asinine, Idiotic response....." the partial in 2013 counts in their 5 year rule even though they did not pay a penny." I was furious and promptly filed an appeal. How in the world can they pull this crap? Did anyone ever hear of such a thing? I am beyond outraged with Aetna who tries to get out of ever paying for anything. It is common sense, they last payed for a partial in 2009 and now are trying to pull this. Did anyone ever have anything like this happen? Other than the appeal which still has not been settled, who can I file a complaint to. I am not going to let them get away with this, I will file complaints with anybody and everybody... 
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inertia40

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Posted 3 years ago

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Spanky

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I think you got hosed.  If the dentist had an approval from Aetna then that should stand.  I would fight like Hell because someone approved it and it should be on record.   Good Luck and keep fighting.
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Norwich Girl

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Be persistent I have had to argue over numerous claims that were rejected for different reasons. Each state I believe has an insurance board they have to answer to. Not sure though on dental insurance. If you google insurance complaints for your State you may be able to find something. The first response from insurance is usually not to pay and they find many reasons to do this which does not pertain to your particular situation. Good luck!!!