Insurance says my lack of care caused my dental implant to fail. Can I fight that?

Hello,

I have Aetna with very limited dental benefits. One of the benefits is that they will cover 50% of an implant every 7 years.

About two years ago I got an implant from my general dentist. After a few months it loosed up and had to be removed. So I never got the tooth placed on the implant (not sure what the replacement tooth is called).

We let it heal and several months later the dentist tried again and installed another implant. He checked it after a week and it seemed fine. Another week passed and it was still more painful than I expected. At the end of the second week, it was getting more painful and as I walked downstairs, the implant fell out of my mouth.

I then went to an oral surgeon to do the implant. I saw that Aetna would not pay for the implant because I had one within the 7 year timeframe – the one that had just fallen out and I was now going to have the oral surgeon replace.

I called Aetna and they started a "complaint" file. I wasn't really complaining (although I probably should have) and just wanted them to pay for the implant because, while the dentist did the work (twice) I still don't have an implant that I, and Aetna, paid for.

Today, I received a letter from Aetna stating that they are not covering the implant being done by the oral surgeon. Also, that "it is noted that you did not properly care for the implants which was a result of the failure."

How is the implant falling out of my head after two weeks a result of my lack of care? In the first instance, while it l could potentially see that it loosened up after several months because maybe I was eating thick taffy every day (I wasn't) or some other lack of care.

Is there any way to fight this?

Thank you for any insight/help.

submitted by /u/sacheltry
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