17 Oct, 2019 → by ClaimboUser447945
denied wisdom teeth removal

1

My daughter was given a referral from her dentist to have her wisdom teeth out. The surgeon sent her xrays and a report to DQ stating she was having headaches, intensive pain, not eating well, under pain medication for over a month and she took antibiotics for the infection, and all 4 teeth were impacted. DQ denied the upper teeth and only approved the lowers. My daughter is being in pain for over a month now. I have appealed the decision and filed a grievance but the receptionist said they do this to Kids all the time. And every time I call DQ say since there's no infection is not medically necessary. They failed to see that she already took antibiotics to prevent the infection to spread. My daughter will get the lowers taken out next week and probably not be able to do the uppers until much later because we don't have the money to prevent her going through this procedure twice. DQ claim that the board reviewing the claims are all dentists but I wonder if that is true because On their website it says that "insurance consultants" make the determination based on submittal of the dental climate form and they can't really say if is medically necessary or not because they do what's on the script for them. Now I have to either come up with over a thousand dollars or wait until my daughter's teeth gets infected or inflamed to get them removed. Just not fair.
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