Hello...my boyfriend just went through and oral cancer scare over the last 8 weeks. He is 25 and has smoked for about 6 years and had 3 pre-cancerous spots removed from his tongue and left and right retromolar regions. We were lucky the dentist caught it early enough and sent us to a great oral surgeon to remove and biopsy the 3 spots. There were 2 procedures about 3 weeks apart. My IL BCBS insurace doesn't contract with oral surgeons but when I called BEFORE the first procedure I was told it would still be paid out at the preferred provider rate b/c they choose not to contract with any oral surgeons. I got my EOB's for the surgeries and they only covered about 40% of them b/c the insurance says my boyfriend had 'dental procedures' done and there are 'caps' or 'allowed amounts' for the procedures and I am stuck paying about $5000. If I have to pay this we have to put off our wedding b/c that's where the money will come from. I am going to appeal the insurance decision but I need help. What kind of documentation can I find to send to them showing that NOTHING was done to his teeth and it is not a dental procedure. I have letters from our dentist and our oral surgeon telling them it is not a dental procedure as well. I am trying to collect as much documentation as I can so I can increase my chances of an approval. If you have any help or resources I can try please let me know. On an positive note....he is officially a non-smoker now!! Thank you so much!! I appreciate all the help you can provide!!

First of all congratulations that your BF stopped smoking and on your plans to get married.

Dental procedures are not limited to procedures only on the teeth.

However, in my experience, biopsies are medical procedures and should be paid by medical insurance. BC/BS is one of the hardest insurance companies to deal with and I have had many fights with them over the years. Sometimes it takes a great deal of fighting to get them to pay. I would call them again and if you get the same answer ask to speak to a supervisor. If the supervisor gives you the same answer, ask them to send you a copy of the part of the policy that shows that they have paid the full amount that he is covered for.

Unfortunately, the 40% might be all that you can get.

Good luck.