Sigh

I have spent so much time fighting with insurance lately. Boy, is it exhausting, frustrating, and disappointing! Don't get me wrong, we're definitely blessed to have insurance coverage. But when you pay your premiums and co-insurances without fail and then the insurance carrier finds a "loophole" and denies coverage, it's enough to drive you batty!

Since June 21, we've been through appeals with medical and dental insurance for the extraction of Beebs' impacted tooth. Here's the kicker... dental insurance will cover the procedure if:

1. it's a wisdom tooth ~ same procedure, different tooth number
2. it's done in a hospital ~ our surgeon prefers to do it in a surgical suite because it's cheaper and now that we've been through appeals, they will not allow us to re-submit with hospital coding
3. it's done without anesthesia ~ the tooth is fully encased in the jaw and will require going through the bone to even get to the tooth and he's 9... no anesthesia, really?

Medical insurance says it's a dental procedure so they've denied all 3 of our appeals, even though our policy clearly states that dental procedures are covered if they are the result of a congenital defect (which his IS). 

We've gone around and around. We've gone back and forth. I've made countless phone calls. I've involved benefits managers and doctors. I've sent scads of documentation, including CT scans and notes from 4 different docs including his craniofacial doctor in Iowa. After EVERY phone call, I've been assured that if I just send "x" document with "x" code, it should be fine and EVERY time it's denied. 

Now, after pushing back all of his treatment by 4 months during this maddening dance, we have exhausted all options and will be paying for it on our own. Months lost and we are exactly where we started. 

Sigh.