PCHP major gripe!

chery2June 4, 2004

Retired w/ disability June 2003 and began having health insurance payments deducted from DH's paycheck instead of mine. Nothing but trouble since. PCHP Dental denied payment on two crowns [$675] saying there was a 12-month waiting period on "serious" procedures.

Geez Louize! If I have a serious problem, I surely don't want to have to wait a YEAR to have it dealt with. Dentist says he sees this sort of denial often with retirees' claims.

What's your take on this? chery-va

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cathyll

We have dental coverage through a different carrier but w/the same results you've had. My only suggestion is to read the fine print in the policy re. exclusions and if no mention is made of "serious" procedures or if "serious" is not defined, I would file a complaint with my state insurance commissioner and see what happens.

    Bookmark   June 9, 2004 at 7:55AM
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maxwell

All dental insurance plans with which I'm familiar exclude preexisting conditions for the first year. I suppose it's so people who already know they need a mouthfull of crowns won't sign up just for the purpose of getting them paid for right away.

You did say that you "began having health insurance payments deducted from DH's paycheck instead of mine." If you stayed with the same dental insurer but transferred the policy to your husband's name, it seems to me that you had continuous coverage and the preexisting condition exclusion shouldn't apply. Of course, if you changed insurance carriers, that's a different issue and I'm afraid you're stuck.

I'd call the insurance people and explain that you were covered all along, but the policy was switched to yur husband's name, if that's your situation. I had a similar experience with Blue Cross, and they did authorize payment after I explained everything to them.

Good luck!

    Bookmark   June 10, 2004 at 1:55PM
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chery2

Maxwell, you are exactly right. I called PCHP to double check on a correction they said they'd make on another claim; the rep said she had evidence showing they had made the correction and paid the doctor [after I'd alread paid the bill]. When I called the doc's office, the insurance person there said the check would be sent to me by the end of the month. Is there any doubt that they never would have send me the check if I hadn't called to "REMIND" them?
When I called to give PCHP an update on that situation, I left a message on the rep's voicemail, saying half-jokingly, "If you have any hand in PCHP's dental insurance, give me a call!" She did, I gave her the details, and she promised to get back to me. Two days later she called and said, "We fixed it! You were insured under your name with us FOREVER." Now I'll have to go back and dig up some of the high pharmaceutical bills I've been paying. . .
Does the squeaky wheel get the grease, or what? chery2

    Bookmark   June 11, 2004 at 11:47AM
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nancyinmich

chery2, great squeeking!

    Bookmark   June 13, 2004 at 11:19PM
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maxwell

Good job!!!

    Bookmark   June 15, 2004 at 3:11PM
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