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Submitted 307 days ago...

CaptsMrs

CaptsMrs

New User (1)

Medical Insurance Lawsuit

I have been denied medical help for an intense and serious medical condition. I am now in appeals, but I need to know if I need to get an attorney or advocate or what?
I have severe bone deterioration in my mouth making me on a scale of 1 to 5, 5 being the worst, I am at 4+. My lower mandible is as thin as a pencil and more fragile than a pencil. I am at high risk for fracture there and the pain I feel is indescribable and what I go through to eat is not healthy at all I believe. I have at least 5 medical professionals who testify that this surgery is medically nessessary. Ins claims it is dental, ( this is the bone structure in my body) and there is no trauma. I have 2 sets of x-rays taken by 2 seperate and different professionls. What should I do next?

 
 
 
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Submitted 192 days ago...

Art223

Art223

Beginner (11)

I could only presume that the insurance that you have is for medical health issues only. That maybe why they are not accepting your claim.
Although the professionals recomment surgery and that it is medically necessary, Your insurance may only cover medical surgery related to health issues only and not dental. The mouth and the jaw bone are considered as dental areas. Dental Insurance covers dental issues which would include the mouth. Medical and Dental Insurances are considered separate insurances. You may need to obtain separate Dental Insurance that would cover pre-existing conditions.
Read your insurance benefits information. It's very important that you understand what you are entitled too.
However, If your Insurance does cover dental issues. I would continue to fight them and hire a good attorney that specializes in Medical Liability cases. Don't just go to any attorney, not all attorneys specializes in these types of cases. Also if your condition was caused by your the type of work you do or did, you may have a Workmans Comp case. Then you would need an attorney for that too. One who speciallizes in WC cases.
I hope the information I provided will help in some way. Good Luck!

 
 

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