Question regarding wisdom tooth extraction claim with unicare?

Heres my situation, im 17 and i just got 3 wisdom teeth pulled because of on/off pains since they were coming in. The problem now is that my mom had to put like $400 up front because apparently Unicare (i have a Unicare Platinum PPO) says that wisdom teeth extraction isnt covered by dental and that it has to be forwarded to medical claims. The weird thing is that my cousins got their wisdom teeth pulled a year or two before me and they have the same provider/plans since both our dads work in the same place and it was completely covered but my aunt cant find the insurance record from that time. I normally think wisdom teeth extraction is covered by the dental plan since there are only a lucky few in the world who have perfect teeth and dont need to get it pulled. Now my problem is that im not sure if my dental office is filling the claim correctly or what since i/my parents also thought it would be covered. My dental officed filled the claim as partial bony %26amp; soft tissue extraction

Question regarding wisdom tooth extraction claim with unicare?
Insurance companies make their own rules on what they will and will not cover. SOme place them under medical, others under dental. You should investigate the plans to see which part of the policy should cover it.





Particial bony means that part of the tooth was located under the bone, and they had to cut it away. SOft tissue means the tooth was under the gum and an incision had to be made to get to the tooth. Every tooth, including wisdom teeth, will have it's own set of circumstances. The code is based on what conditions exhist in the mouth, and how difficult it is to extract it. The dentist may think it is only under the gum, then get inside to find bone on top of the tooth, and have to change the procudeure in the middle. Try getting a copy of the claim form and the phone number to the insurance company. Call them and ask why they are not covering it. The insurance companies are much nicer to the patient than they are to the dental office. Remember the insurance companies do not WANT to pay, so it is often a struggle to make them pay.
Reply:i had my wisdom teeth pulled 2 years ago, and it was covered on the health plan not dental.





however, the trigger for it to be covered on the health plan was the fact that they were impacted. if they were not impacted they would have been covered by dental.





i had BCBS PPO and Delta Dental at the time.
Reply:I'm in this exact same situation. I have a co-worker who had the procedure done (same group plan) and his was NOT COVERED by medical, so the dentist sends the EOB to Dental insurer and they covered. His procedure must have been full bony. My claim was accepted as covered on all line items, even though only one was a soft tissue extraction. Of course, medical applies to deductible first and therefore I pay the first $400. If they had not covered the whole claim, my dental deductible would have been used, which was only $50. I've researched this to death. They really try hard not to give you information that you can use. I've almost got it figure out though on how to proceed. Click on my profile name and shoot me an email or IM and we can share some info and navigate this together.



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