- Jurisdiction
- New York
I'm in NY state and my insurance provider is Fidelis.
For 3 years I have been trying to get to a dentist but there are no providers within a 100 mile radius that are accepting new patients and accept Fidelis. I have gone in circles with Fidelis who consistently, over 3 years, provides an outdated list of dental providers. I saw a dentist out of pocket two years ago who advised me that the majority of my teeth could be saved and that all I would need is a partial mini implant denture. Unfortunately, since he doesn't accept Fidelis he wanted 30k cash. I don't have that!
After threatening Fidelis with a negligence suit I was finally seen by a dentist who, after reviewing my xrays states that I am now in need of a full mouth extraction. The dentist states that he doesn't know any oral surgeon he can refer me to that takes Fidelis. He says there are no Fidelis oral surgeons within a 100 mile radius that he knows of. He states that he wants to pull 28 teeth, in one sitting, under local anesthesia.
If you've ever had a tooth pulled, you know how excruciating it is.. 28 times over. When I asked why I couldn't be put under full anesthesia, the dentist tells me that he doesn't know anyone qualified to do full anesthesia, and that he has no one to refer me to as far as surgeons go. When I told him that because of the level of pain that will be involved I would prefer to be sedated under full anesthesia and asked if he is positive that Fidelis has no oral surgeons in all of NY? He said no.
At the end of the visit the dental assistant asked the dentist, "what's going on? Are we scheduling a follow up, giving a referral, what are we doing"? The dentist responded, "we are going to nothing". He said to "put a reminder on the calendar for a couple of weeks and we'll deal with it then".
I left the office with no referral, no follow up appointment, and on a scale of 1-10 I am living in rank 10 pain with no antibiotics, no pain medication and no treatment in sight.
When I got to the parking lot I immediately contacted Fidelis and the rep told me that I'm being unreasonable. She said that if the dentist recommends a full 28 tooth mouth pull under local anesthetic, then I should be thankful that he's offering the treatment that I asked for and stop being so entitled. She states that I should be thankful that I am going to be subject to 8 hours of war torn torture.
I asked for and have been asking to see a dentist for 3 years and this insurance company has me living in chronic pain, I have lost the opportunity to save ANY and ALL teeth as a result of their negligence and I STILL don't have a follow up appointment to at least pull the one tooth that has me doubling over in pain!
Is there any course of action I can take?
edit: I have been on 3 different year long wait lists and without fail, the day before my appointment, the dental office calls and cancels my appointment. They wont make room for me, they only offer to put me on a new wait list which is now 2 to 3 years long. I have gone around in circles with Fidelis who continually supplies obsolete provider lists and they always claim to be looking outside of the set 100 mile radius, "we'll call you back when we find a dentist for you" but that call never comes.
What do I want NOW? Immediate dental care! I want a full sedation extraction and no out of pocket costs for any required care that is the result of lack of care for the last 3 years which most likely will include permanent snap in dentures. I feel if Fidelis covered me as they should have I would not need full pull and full dentures. This is their fault!
Do I have enough of a case to sue for this and win?
For 3 years I have been trying to get to a dentist but there are no providers within a 100 mile radius that are accepting new patients and accept Fidelis. I have gone in circles with Fidelis who consistently, over 3 years, provides an outdated list of dental providers. I saw a dentist out of pocket two years ago who advised me that the majority of my teeth could be saved and that all I would need is a partial mini implant denture. Unfortunately, since he doesn't accept Fidelis he wanted 30k cash. I don't have that!
After threatening Fidelis with a negligence suit I was finally seen by a dentist who, after reviewing my xrays states that I am now in need of a full mouth extraction. The dentist states that he doesn't know any oral surgeon he can refer me to that takes Fidelis. He says there are no Fidelis oral surgeons within a 100 mile radius that he knows of. He states that he wants to pull 28 teeth, in one sitting, under local anesthesia.
If you've ever had a tooth pulled, you know how excruciating it is.. 28 times over. When I asked why I couldn't be put under full anesthesia, the dentist tells me that he doesn't know anyone qualified to do full anesthesia, and that he has no one to refer me to as far as surgeons go. When I told him that because of the level of pain that will be involved I would prefer to be sedated under full anesthesia and asked if he is positive that Fidelis has no oral surgeons in all of NY? He said no.
At the end of the visit the dental assistant asked the dentist, "what's going on? Are we scheduling a follow up, giving a referral, what are we doing"? The dentist responded, "we are going to nothing". He said to "put a reminder on the calendar for a couple of weeks and we'll deal with it then".
I left the office with no referral, no follow up appointment, and on a scale of 1-10 I am living in rank 10 pain with no antibiotics, no pain medication and no treatment in sight.
When I got to the parking lot I immediately contacted Fidelis and the rep told me that I'm being unreasonable. She said that if the dentist recommends a full 28 tooth mouth pull under local anesthetic, then I should be thankful that he's offering the treatment that I asked for and stop being so entitled. She states that I should be thankful that I am going to be subject to 8 hours of war torn torture.
I asked for and have been asking to see a dentist for 3 years and this insurance company has me living in chronic pain, I have lost the opportunity to save ANY and ALL teeth as a result of their negligence and I STILL don't have a follow up appointment to at least pull the one tooth that has me doubling over in pain!
Is there any course of action I can take?
edit: I have been on 3 different year long wait lists and without fail, the day before my appointment, the dental office calls and cancels my appointment. They wont make room for me, they only offer to put me on a new wait list which is now 2 to 3 years long. I have gone around in circles with Fidelis who continually supplies obsolete provider lists and they always claim to be looking outside of the set 100 mile radius, "we'll call you back when we find a dentist for you" but that call never comes.
What do I want NOW? Immediate dental care! I want a full sedation extraction and no out of pocket costs for any required care that is the result of lack of care for the last 3 years which most likely will include permanent snap in dentures. I feel if Fidelis covered me as they should have I would not need full pull and full dentures. This is their fault!
Do I have enough of a case to sue for this and win?
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