My issue with the denture is that they covered it as per her policy @ 70% originally. We then paid 100% for 7 of the 8 implants that replaced it and VHI is making a contribution towards just one of them. Now based on this they determined that the denture was temporary(she wore it for 11 months) and deducted that amount from the implant claim. If I get pedantic the denture only covered 6 teeth, I could say VHIs contribution was towards one of the teeth not covered by the denture so what business is it of theirs if she subsequently at her own expense replaced the others with implants they didn't contribute too! I've submitted a complaint and am awaiting their response I just wanted to get some opinions on here too while I wait for their reply.I'm confused after reading that and can't identify the key issues.
Do you know that the claim should have been paid?
If so make an appeal/complaint to VHI.
If they stick to their guns and don't explain things clearly then get a final response letter from them and take it to the Ombudsman?
Did your wife get a code from the dentist and check with VHI if it was covered before she got the dental treatment done?
The FSPO deals with health insurance complaints but, as I said above, will only do so after the insurer's complaints/appeal process has been exhausted first and a final response letter issued.Is there an ombudsman for insurance. I assume there is. You could ask them.
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