Dental insurance - Disagree with recommendation
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If your insurer disagrees with your dentist as to the appropriate treatment for you and whether it should be covered, you should look into the details of your policy and see whether the policy makes it clear either was as to whether your treatment can be covered. If it is unclear you should write to your insurer giving clear details of your requirements and why you believe they are within the policy. A copy of a supporting letter from your dentist or specialist should be enclosed if possible.
If you disagree with the claim findings you should contact your insurer and write giving clear details of your case - such as what happened, when, and why you think you think the conclusion is inaccurate. You should enclose within this letter copies of all receipts for treatment upon which you will be relying. Their customer services team should assure you that they will contact you within a reasonable time with an update regarding your dispute.
As a last resort you can contact the Ombudsman, which will act as a mediator in your case. resolver recommends that you submit your concern in writing, and resolver can assist you in submitting, recording and reminding you when and who to escalate to.
Resolver can help you resolve this issue quickly, free of charge and without the hassle. We can also help you with the next step of writing your complaint. Click on the link below to create your email.
You should know
- If you’re making a complaint about making an insurance claim rather than a mis-sold policy, check your documents to see who the “underwriter” is. You’ll need to make a complaint to that organisation.
If you cannot resolve your issue you cannot raise your case to the Ombudsman until 8 weeks after you have first raised your complaint with your supplier, or you have received a ‘letter of deadlock’ from the company stating that they cannot resolve the issue as you have asked. Your complaint must also not be older than 9 months. For an accurate decision by the Ombudsman you should provide a detailed file of your communications and supporting documentation. In addition make sure you explain what you want as an outcome as this will help assess your case.
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