Delta Dental Insurance / 90 Day Waiting Period for Root Scaling

Pittsburgh, PA, United States

I had tooth and gum pain that began in mid-May. I have been struggling with it since. My gums are very inflamed, red and swollen, making it very difficult to talk and eat. I have not been feeling well because of it. Sometimes, I feel like I'm running a fever because of it and feel tired a lot of the times. I have also been breaking out into little red hives, which started soon after the mouth pain, so I think they're related. I had an appointment with my periodontist today. I had taken a sick day from work because I did not know what was causing the inflammation and pain, and I expected whatever needed to be done was going to be more extensive than just a regular cleaning. My periodontist first took x-rays, then measured my gum pockets, and did a regular cleaning to determine if I needed a root planing. Based on the results, my dentist said that a root scaling was needed. They could do half the first time, and then the other half the next. I said I am willing to have the first half done today, if they can fit me in their schedule. I have already been in enough pain, and I did not want to wait any longer. They looked and said they did have time today. S0 I ate breakfast, ran a few errands in between appointments. I come back and the receptionist informs me that they have called Delta Dental to see if it was OK to do the root planing today. They told her they wouldn't cover the root scaling today, and that I would have to wait 90 days before I could have it done, if I wanted them to cover it. My root planing without insurance would cost me $800.00. With the insurance, it would have been $140.00. Big difference in cost. I was really disgusted with this decision, and decided to call the Delta Dental myself and complain to them. Delta Dental told me that this was their policy. I asked them what is the basis for this policy, and they couldn't give me an answer. I said the doctor and I have already determined that I need this root planing as soon as possible, so why the 90-day rule. I told them it shouldn't be up to you to decide if and when I receive care, especially when you are not the one who's actually providing the care. I told them this policy allows for negligent care, and that I would complain to the Better Business Bureau, and even sue them if that's what it came down to. Still they would not budge, and only thing they did was provide me with an address I could mail a complaint to. I am so angry with them. What if I had oral cancer and the insurance company just decided that I'd have to wait a year to have anything done about it. Think about that one. What right do insurance companies have in telling patients how long they have to wait before getting treatment? Having to wait for care is just plain ridiculous!

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