We hope everyone's weekend is going well! Don't let the weather wear you down, we've got some new information for you!
Although crowns and bridges generally last longer than five years, in some cases, they may need to be replaced earlier. This can pose a problem as most dental coverage will not cover replacement of a crown or bridge if it is less than five years old. Generally speaking, most dental policies have guidelines or time frames as to when a replacement crown or bridge becomes eligible again. However, many insurance policies have left it open for interpretation, by putting nothing in writing or putting in as “reasonable and customary.”
In the dental industry reasonable and customary usually refers to 5 years. However, if the insurance company does not clearly state this in writing, they have no grounds in which to reject a claim. If your claim is rejected based on a 5 year time line it can be appealed and won. All that is needed is a letter of appeal to the insurance company requesting to clearly state the page number and paragraph of such.
As a result, usually, a pay out the claim is made even if it is only 4 years old as they have no way of proving the time line of five years.
For more information and how to put together a letter of appeal, please contact our office.