Donna’s Dental Dilemma: A Fight for Coverage and Answers

When teacher Donna Calhoun bit into an apple and lost a tooth, she did not expect the dental emergency and bureaucratic nightmare that followed. With a Cigna dental PPO plan from her former employer, which she had been paying into for a decade, she expected coverage, but finding an available appointment in-network proved difficult as her condition worsened, leading to a fever and infection. Reluctantly, she sought out-of-network treatment, shelling out $405 for the deductible, thinking the matter was resolved. But when she filed her claim, Cigna’s response was perplexing. Denials arrived without explanation, and despite repeated attempts for clarification, the silence continued. While she has since retired, at the time of this incident she was still working in the Fayette County public school system. Yet, her former employer’s HR department offered no assistance, leaving Donna to navigate the dental health system alone.

Since the incident, Donna was told she owes an additional $888 for the procedure which has grown to over $1,174 as time passes, for which collection agencies have been regularly hounding her, but still has not heard anything back from her insurance provider. Donna looked into health care transparency legislation, but unfortunately, these policies only apply to medical plans, while dental plans are not held to the same standards.

At Families USA, we believe that oral health care is a critical component of overall health, and we must continue to push for comprehensive coverage to protect patients like Donna from experiences like this.