u/squishymeowsers

So it’s been awhile since my last dentist visit, and I know I’ll need some work done(impacted wisdom teeth removal)

There’s a dentistry that has treated me well in the past, and I found out right after scheduling an appointment with them, that although they still take Anthem BCBS, the dentist that would work on me would be out of network for the specific type of PPO I have 🤷‍♀️ I would have to pay 50% of x amount vs the cleaning and exam being 100% covered.

After calling my insurance, I learned my current Anthem dental plan has a yearly maximum of 1k, which isn’t great, so my insurance agent recommended Aetna, which is in network with my dentist AND has no maximum cap AND no waiting periods- you only pay copay amounts per procedure/visit, with preventive covered completely.

It feels too good to be true, I would just pay $50 a month for only myself, and if I wanted major work done it explains it would be $125-500 per procedure, dependent on what type of services(ex. Cavity vs root canal)

My gut is telling me there is something amiss here, does anyone have any experience with Aetna Dental? Do they often deny claims? Why does this feel like a great insurance with a scammy caveat?

I read up on their limitations and exclusions section and there’s a little bullet mentioning services will not be covered if “not medically necessary” 🤔

Any guidance is appreciated 🙏