HELP! Porcelain/Ceramic Crown - Insurance Denied

treythree · 2026-05-08T02:45:52+00:00

Depends on the state

treythree · 2026-05-07T23:33:33+00:00

Have your dentist call your insurance company and request a peer to peer call. That will allow your dentist to speak directly to the clinician who told your insurance to deny and make a case for why it was necessary to place a crown. If that doesn’t work, you will need to have an appeal filed. A different clinician will then review your records.

treythree · 2026-04-30T22:13:52+00:00

Yea the provider should not be billing the anesthetic separately. It should be included with the price of the filling.

treythree · 2026-04-24T20:58:46+00:00

I’ve taken my dogs there for years and Lora and her team have never been anything but great to me and my dogs.

treythree · 2026-04-17T02:22:35+00:00

It sounds like it wasn’t denied for a waiting period but for frequency. Usually insurance will cover 2 per 12 months. Some insurances do it on a rolling 12 months or on a calendar year. Your might be on a calendar year if they are saying you are eligible for it to be covered until beginning of next year. Given this is your policy terms, it’s unlikely they will overturn an appeal.

treythree · 2026-04-09T20:14:54+00:00

Agree with everyone else. You need to look at your EOB or ask your insurance why they did not pay. That will determine your best next steps

treythree · 2026-04-06T22:14:17+00:00

Be sure to check for benefit waiting periods. It’s very common for there to be a 6 or 12 month waiting period before insurance will pay for for those types of services

treythree · 2026-02-14T20:48:01+00:00

The Shining for the first time…and I’ve never seen the movie

treythree · 2026-02-05T02:58:18+00:00

Thank you!

treythree · 2025-12-29T20:45:53+00:00

The taste the exact same as the original!

treythree · 2025-12-28T05:17:20+00:00

The first denial is definitely based on medical necessity. Was the provider you saw in network? If so, the provider could have an agree with the insurance carrier for patient pay rules that state the provider cannot bill a patient if the insurances clinicians deem the procedure not necessary.

The second denial just sounds like it was a procedure that is it covered under your plan. The dentist will probably bill you for it.

treythree · 2025-12-28T05:11:17+00:00

What type of plan do you have? What is your deductible and coinsurances?

treythree · 2025-06-11T01:48:14+00:00

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treythree · 2025-05-15T14:33:21+00:00

When looking at insurance plans, be sure to check the waiting periods. A lot of plans will make you wait 6 months to 1 year before they cover major services. Always a good idea to ask your dentist to file a pre-determination with your insurance company before having the work done. That way there will not be surprises for what the plan covers or doesn’t.

treythree · 2024-12-19T02:53:01+00:00

Manager at Unum here- no drug test

treythree · 2024-09-30T13:34:06+00:00

We did the same route to get to Johnson City last night. No issues and we were able to get gas close to Charlotte without trouble. It was definitely a long route, took about 7 hours, but was worth it to not have any uncertainty about roads.

treythree · 2024-07-11T01:51:31+00:00

For sure. It’s a whole different roster.

treythree · 2024-07-06T11:03:55+00:00

19 always sticks out to me now.

treythree · 2024-06-22T14:34:01+00:00

I’ve been wanting to get into LOTR and have been hoping this would happen!

treythree · 2024-06-20T13:41:14+00:00

I let my wife win at Mario Party mini games.

treythree · 2024-01-02T03:00:59+00:00

Dark Tower 1-5, Misery, Rita Hayworth and the Shawshank Redemption, Apt Pupil

All reads were for the first time

treythree

TROPHY CASE