Holland Woman Fights Insurance Company For Coverage and Wins

HOLLAND, Mich. (May 14, 2014) — The FOX 17 Problem Solvers introduced viewers to Annah Hilary in April. The 17-year-old from Rockford lost 5 of her teeth in a longboarding accident a year ago.

Her medical and dental insurance told her they won’t cover the costs for dental implants.  Both Blue Care Network and Aetna Dental said it’s not a covered benefit, and her family said it’s being told implants are considered cosmetic. Hillary created a Gofundme page to help raise money for the procedure. She also turned to FOX 17.

“I just felt so bad for that girl when I seen her,” Betty Vandenburg, a Holland resident said.

“It just brought up all this anger again,” she said she’s been in the same boat.

Vandenburg explained, “I caught my foot on the curbing and then when I caught my foot on the curbing, I fell flat on my face.”

The fall knocked out two of her front teeth. She said a dentist put them back in, but one of the teeth couldn’t be saved.  She needed a permanent fix, a dental implant that would cost her $4,500.

Vandenburg expected her Blue Cross Blue Shield insurance to cover the cost.

She said, “They started paying on the implant itself, the rod implant.  But once the rod was in, they said
that they weren’t going to pay for the tooth. So what? I was going to go around with this rod hanging out of my mouth? Come on now!”

She said her medical insurance told her it would fall under dental coverage.

“It’s so frustrating because you pay all this money into your insurance company, ya know, over all these years and then finally you need it for something, and they’re fighting you all the time. And my dentist and my implant guy said I would never get my money,” Vandenburg said.

But she wrote letters and filed a grievance and appeals.

“I pay over $1600 a month in health insurance for my family,” she read from one letter. “I do not intend to drop this matter without a fight.”

After repeated denials, her last recourse was mediation with the state office in Lansing that oversees insurance claim disputes.

“Within days, I had the check,” she said.

The state and Blue Cross informed her that Blue Cross would reimburse her the $4,500 for the dental implant.
Now she’s encouraging Annah Hillary and her family to be persistent, to fight, and go to the state because her health depends on it.

Vandenburg said, “It just absolutely broke my heart when I seen her because I know she’s not going to have the jaw bone in there, and you can’t have it done. There’s a time frame here. Where she has to have it done.”

A spokesperson with the Blue Care Network said there may be differences between Blue Cross medical coverage that Vandenburg had and the Blue Care Network Hillary has.

3 comments

  • Livid

    Oooh that is gruesome!
    I am happy that this lady won though! The insurance industry is out of control across the board! And Obamacare is not helping either, Medical, Dentistry also takes great advantage of people who are in dire straits!!!
    No one should ever have to go without teeth!

  • Barb

    My daughter tripped and hit a curb face first and shattered her two front teeth. They had to pull them out and she chipped two other teeth. She does not have insurance. :-( The Girls at my work passed a card around to collect money to help her pay for the fist part of her bill. What a great group of people I work with. :-) That money helped with a little portion of her first day at the dentist. Her first day at the dentist was almost $2,000, because she had to be put out to get the two front teeth pulled. She told them she did not have the money to be put out to just pull them, the surgeon said I will not pull these out with you awake, I can not even touch the inside of your mouth with out you jumping because it was so sore from all the cuts on the inside of her mouth. After she got the two teeth out, It was back to the dentist office to get fitted for a flapper, this was all in one day. She works with the public so she could not run around with out teeth. One of the dentist she had gone to told her to check the place she hit the curb because it was in a parking lot they should have insurance to cover accidents. When she called and talked with a few different people they told her they do not have insurance to cover accidents in that parking lot. She went to a couple different dentist to get quotes on implants and they all told her she would need to get braces first before they would put implants in. This only cost a little under $6,000 I got a loan out for her to do this and we are still paying on it and her braces will be off at the first part of June. No she will not have money for her implants and can not get another loan so she will have to get another flapper that falls out all the time. As I said she works with the public and that is not cool when you are talking to one of your clients and your front teeth fall out. She is hoping she can figure out how to pay for implants before the bone starts to deteriorate. So it is frustrating with or with out insurance. She/We have paid out almost $8,000 and still no implants. :-( I for got, when it first happened she did not go to the hospital because she does not have insurance and did not want another bill.

  • lol!

    Ouch! Happy she won! If dentists would lower their prices, Maybe people could afford dental care- People don’t stop going to the dentist out of fear of pain, They can’t go because of costs! Theres more to say, But thats it for now!!!!!

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