How do I get braces covered under my dental benefit to maximize insurance help?

[ilin59]

I recently switched dentists and they told me my jaw alignment is basically fucked and it causes me to wear down my back molars way faster than they should be and projected I’ll lose probably 4-8 of my back molars and need root canals for them before I’m 40 at this rate. She said if I want to avoid that I need to get braces to change some alignment, then oral surgery to fix my jaw, and then braces again to adjust to the new jaw placement. I’ve already gone for a second opinion and they basically said the same thing.

I checked my dental coverage through work (Cigna) and there is some help for braces but it’s only $1,500 (out of the expected $8k+) because braces are considered elective. The thing is, this is obviously medically necessary to keep my teeth and I’m not looking to go get braces for a nice smile.

Is there some way I can get the services reclassified under one of my other benefits (e.g. preventative, since I’m preventing more expensive root canals in the future) so I get better help from insurance? And if so, how would I do that? Do I contact someone at my employer since they’re the ones who negotiated our benefit package? Or is there some form I send to Cigna to ask for an override? Please help!

 

[ngocvncom]

@ilin59 No, you're not going to be able to get braces reclassified. The insurance company is going to cover $1,500, you're going to have to cover the rest.

Elective in this context doesn't mean they don't think it's medically necessary. It means its at your discretion when and if to get them done and is not an insurable risk. If they covered braces with no maximum, people who needed braces would buy policies, get the braces paid for, and then drop. They would have to jack the premium way up to cover that and dental premiums would be unaffordable.