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| Joined: Apr 2010 Posts: 1 Member | OP Member Joined: Apr 2010 Posts: 1 | 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!! | | |
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