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- Oct 13, 2010
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Has anyone been able (or tried) to get their PPACA policy to cover "third molar" (aka wisdom tooth) extraction for their age <19 kid?
I resisted having my daughter's wisdom teeth removed, but she started having impaction issues, so since she was less than 19 at the time, and the policy said (extracted salient parts):
I've done a little searching and found a few pre-passage (of the PPACA) discussions that said that there was a wish that there was more guidance on the more expensive procedures (like wisdom tooth extraction). Apparently the law says "medically neccesary". Maybe that's the wiggle room? My thinking is that if one insurance company is paying for certain procedure codes (involving impaction of wisdom teeth) and another is not, then one of the insurance companies is messing up.
Any experience out there, or hints for finding a precident?
I resisted having my daughter's wisdom teeth removed, but she started having impaction issues, so since she was less than 19 at the time, and the policy said (extracted salient parts):
I thought "How can they wiggle out of that?" Well, they (BCBSNC) are trying mightily to do just that.Pediatric Dental Services (this benefit is only available for members up to age 19):
Basic and Major Services -
* Simple Extractions
* Surgical removal of teeth
* Anesthesia limited to deep sedation and IV when clinically necessary and related to covered complex surgery
I've done a little searching and found a few pre-passage (of the PPACA) discussions that said that there was a wish that there was more guidance on the more expensive procedures (like wisdom tooth extraction). Apparently the law says "medically neccesary". Maybe that's the wiggle room? My thinking is that if one insurance company is paying for certain procedure codes (involving impaction of wisdom teeth) and another is not, then one of the insurance companies is messing up.
Any experience out there, or hints for finding a precident?