New Implant – Insurance coverage (Laya)

Alzone

I have the dental connect plan from Laya Healthcare so I contacted them to ask what type of cover can I expect. It seems that because the implant will be on the upper jaw, there is no cover. However the agent explained to me that if it was on the lower jaw, the implant would be covered. She explained to me that the reasons is because we only need the lower jaw teeth to chew and not the upper teeth.

Did anyone even come across this situation? Is there a way I can appeal knowing that from their benefits list it states the following:
Prosthetic services - Bridge and Implant Supported Crowns 70% refund - 1 every 5 years

Thanks,

Oral Surgeon

Alzone wrote: »

I have the dental connect plan from Laya Healthcare so I contacted them to ask what type of cover can I expect. It seems that because the implant will be on the upper jaw, there is no cover. However the agent explained to me that if it was on the lower jaw, the implant would be covered. She explained to me that the reasons is because we only need the lower jaw teeth to chew and not the upper teeth.

Did anyone even come across this situation? Is there a way I can appeal knowing that from their benefits list it states the following:
Prosthetic services - Bridge and Implant Supported Crowns 70% refund - 1 every 5 years

Thanks,

Medical insurance can give a small amount towards lower implants if the patient has absolutely no teeth and can't eat effectively with dentures alone but this is a small proportion of the overall cost and must be approved in advance.
Dental insurance may help a lot more....
Sounds like you were talking about your dental plan and they were talking about your medical plan.....

Alzone

Many thanks for your reply. It can be the case that they didn’t check the dental plan but only the medical plan, I will double check with them.

Also, I have received the following from Laya:
Codes 3016 through to 3022- we cover the surgery on an Outpatient Surgical basis for lower jaw only, no benefit is available for upper jaw implants. In addition, a grant-in-aid of €532.29 is payable per implant towards the cost of the implant components. This cover is subject to pre-cert and a dental x-ray is required

Oral Surgeon

Alzone wrote: »

Many thanks for your reply. It can be the case that they didn’t check the dental plan but only the medical plan, I will double check with them.

Also, I have received the following from Laya:
Codes 3016 through to 3022- we cover the surgery on an Outpatient Surgical basis for lower jaw only, no benefit is available for upper jaw implants. In addition, a grant-in-aid of €532.29 is payable per implant towards the cost of the implant components. This cover is subject to pre-cert and a dental x-ray is required

That's the medical insurance conditions and here is the full conditions... Talk to the dental insurance guys instead....