Wellness

[Puppy Lips]

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@reiki604 wrote:

This thread saddens me. I see a parent teaching her children that responsibility for oneself is not important and that rules, regulations and restrictions are for other people. What the OP is teaching by example is entitlement. Now we can see how it starts. I hope the OP never complains about the sense of entitlement others have.

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@reiki604Oh please, my son is 20, and was on a break between college and a summer internship.  He is on our dental plan and is not even aware any of this is going on.  This is not "entitlement" because we pay for the dental insurance.  Anyway it is settled so you can take your indignation elsewhere.

[AuntMame]

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@Puppy Lips wrote:

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@reiki604 wrote:

This thread saddens me. I see a parent teaching her children that responsibility for oneself is not important and that rules, regulations and restrictions are for other people. What the OP is teaching by example is entitlement. Now we can see how it starts. I hope the OP never complains about the sense of entitlement others have.

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@reiki604Oh please, my son is 20, and was on a break between college and a summer internship.  He is on our dental plan and is not even aware any of this is going on.  This is not "entitlement" because we pay for the dental insurance.  

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Since he is 20 maybe it's time that mom be relieved of dental care duty and the college junior be encouraged to make his own dental appointments as well as make sure that the dentists get paid? 

[reiki604]

@Puppy Lips: Please review the definition of entitlement in the way it was used. The fact you paid for insurance does not mean you get to choose the terms of your policy. The belief that it does indicates that you want the rules apply differently to you.

en·ti·tle·ment

inˈtīdlmənt,enˈtīdlmənt/

noun

1. the fact of having a right to something.

   "full entitlement to fees and maintenance should be offered"

   synonyms:

   right, prerogative, claim; More

   • the amount to which a person has a right.

     "annual leave entitlement"

     synonyms:

     right, prerogative, claim; More

   • the belief that one is inherently deserving of privileges or special treatment.

     "no wonder your kids have a sense of entitlement"

[Puppy Lips]

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@reiki604 wrote:

@Puppy Lips: Please review the definition of entitlement in the way it was used. The fact you paid for insurance does not mean you get to choose the terms of your policy. The belief that it does indicates that you want the rules apply differently to you.

en·ti·tle·ment

inˈtīdlmənt,enˈtīdlmənt/

noun

1. the fact of having a right to something.

   "full entitlement to fees and maintenance should be offered"

   synonyms:

   right, prerogative, claim; More

   • the amount to which a person has a right.

     "annual leave entitlement"

     synonyms:

     right, prerogative, claim; More

   • the belief that one is inherently deserving of privileges or special treatment.

     "no wonder your kids have a sense of entitlement"

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@reiki604Well if YOU had read my post, you will know that my son does not even know anything about this dispute.  He is back at school, and had we not taken the appointment that we did, he would have gone a year without a dental cleaning.  We appealed the denial.  Why do they even have an appeal process at all if no decisions can be reversed?  You think it is asking for special treatment to use the appeal process?  It is not like we were trying to scam the insurance company and get in even more dental cleanings.  We were just asking for common sense on the part of the insurance company, which appears to be lacking in this situation.  My boys do NOT have a sense of entitlement.  I do NOT need definitions from you and I will not discuss this further with you.  

[Puppy Lips]

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@AuntMame wrote:

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@Puppy Lips wrote:

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@reiki604 wrote:

This thread saddens me. I see a parent teaching her children that responsibility for oneself is not important and that rules, regulations and restrictions are for other people. What the OP is teaching by example is entitlement. Now we can see how it starts. I hope the OP never complains about the sense of entitlement others have.

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@reiki604Oh please, my son is 20, and was on a break between college and a summer internship.  He is on our dental plan and is not even aware any of this is going on.  This is not "entitlement" because we pay for the dental insurance.  

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Since he is 20 maybe it's time that mom be relieved of dental care duty and the college junior be encouraged to make his own dental appointments as well as make sure that the dentists get paid? 

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My son is on a family dental plan that takes kids until they are 30 years old.  He is 4 hours away at college and does NOT have a car.  I am not going to ask him to find a local dentist that takes our insurance, make an appointment that fits in with his 18 hours of classes, an on campus job, and tons of homework, have him hire an uber car to get there, and another uber car to take him back to his appartment.  If you want to put that responsibility on your kids, then so be it.  But I am not going to put that responsibilty on him in his currrent situation.

[Laura14]

@Puppy Lips  Glad you got it resolved and forget about anyone else's opinions.  You do you and from what I can tell from this post you do it quite well. 

I honestly wondered why the software wasn't flagged with the insurance limitations since I assumed these days most dental software should have something basic like that built into it.  Glad to know it's in there correctly now.  

Next!  

[Carmie]

@Puppy Lips  I worked in the appeals department of an insurance company and I  know for a fact that writing an appeal will not reverse the denial of a services that is not covered or paid or denied correctly under the terms of your contract.

A written appeal sometimes will include additional information that was not included on the original claim that would change the denial...like a medical necessity issue.

Sometimes the provider reports an incorrect diagnosis or procedure...an appeal would start a formal review that might affect the outcome.

Sometimes there is a break in coverage or it is cancelled, then reinstated.  A claim might have been received during these dates.  A claim can be reprocessed if an appeal is received...a phone call will work this case too.

If you are given incorrect information by the insurance company that lead you to believe that your services were a covered benefit, when the services are excluded, sometimes an appeal will get the claim paid.  Phone calls are recorded and the information given can be listened to to make that decision.

In other words...an appeal can overturn a denied claim if the claim should have been paid in the first place.  If the service is excluded, not covered according to the terms and conditions of your contract, an appeal won't help.

Insurance companies used to make exceptions, but they can no longer do so. Their hands are tied by laws and extremely high fines if they get caught during an audit.  

The benefits are clear as day and in black and white.  There is no common sense issues that will overturn the denial of your son's dental claim.  If simply cannot be done..not for you or anyone else.

[Sooner]

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@Kachina624 wrote:

I think Cigna is spliting hairs.  I'd complain to my state insurance agency, the one that regulates insurance companies.  In the meantime pay your bill.

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@Puppy Lips  Nope.  I had this happen.  It's my responsibility to follow the rules.  If they let one do it how is it fair to othes?  And what, 3 days, 6 days?  Where do you draw the line?  

I don't understand how come people don't think rules and laws apply to them today?  It's in the contract.  If they don't go by the contract you'd be hopping mad wouldn't you?  So how come the contract doesn't really apply to you?

I don't get why OP is upset with anyone but herself.  Sorry but I just think respect for a contract has to go both ways. 

[Puppy Lips]

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@Laura14 wrote:

@Puppy Lips  Glad you got it resolved and forget about anyone else's opinions.  You do you and from what I can tell from this post you do it quite well. 

I honestly wondered why the software wasn't flagged with the insurance limitations since I assumed these days most dental software should have something basic like that built into it.  Glad to know it's in there correctly now.  

Next!  

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@Laura14 Thank you.  With some of the comments, I was starting to remember why I stopped starting conversations long ago.

[Carmie]

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@Puppy Lips wrote:

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@AuntMame wrote:

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@Puppy Lips wrote:

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@reiki604 wrote:

This thread saddens me. I see a parent teaching her children that responsibility for oneself is not important and that rules, regulations and restrictions are for other people. What the OP is teaching by example is entitlement. Now we can see how it starts. I hope the OP never complains about the sense of entitlement others have.

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@reiki604Oh please, my son is 20, and was on a break between college and a summer internship.  He is on our dental plan and is not even aware any of this is going on.  This is not "entitlement" because we pay for the dental insurance.  

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Since he is 20 maybe it's time that mom be relieved of dental care duty and the college junior be encouraged to make his own dental appointments as well as make sure that the dentists get paid? 

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My son is on a family dental plan that takes kids until they are 30 years old.  He is 4 hours away at college and does NOT have a car.  I am not going to ask him to find a local dentist that takes our insurance, make an appointment that fits in with his 18 hours of classes, an on campus job, and tons of homework, have him hire an uber car to get there, and another uber car to take him back to his appartment.  If you want to put that responsibility on your kids, then so be it.  But I am not going to put that responsibilty on him in his currrent situation.

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Your dental policy allows children/adults up to age 30 cost $94 a month and you cancelled it?!!!

Yeah right!   Something is not right here.  Me thinks you better go back and read your policy again.  If what you said is correct,why in blue blazes would you cancel the golden dental family plan of the century?