LAKE WALES, Fla. (WFLA) – Dave Sayers has been waiting for new prostheses since January and says he was stunned when he picked them up in September and discovered they didn’t fit.
“It was pretty obvious to me. I’ve had a couple of dentures made over the years and knew damn well they wouldn’t even come close, ”said Sayers.
Sayers has Medicare and a supplement through CarePlus and Arugus Dental. Dentures are covered every five years. He says he was sent to Dental Associates in Winter Haven to get the dentures.
When they didn’t fit, he was told to wait a few days to see if it got better. Sayers says the pain only got worse.
“The actual plate itself was so tight that I was in great pain myself when biting the actual gums,” he said. “I couldn’t even speak to these new plates they made.”
So he left the prosthesis in the doctor’s office. He says insurance agents sent him to another provider to customize. But then came more bad news: he was denied coverage. He was told it was because the insurance company had already paid for the set that didn’t fit.
Sayers was told he would have to wait another five years. He appealed but was informed this week that it would take up to 30 days for a decision to be made.
So he knew he’d better call Behnken. Investigative consumer reporter Shannon Behnken left messages for the insurance company and visited the dentist’s office.
A representative from the office called back and said she had contacted the insurance company and had already filed a corrected claim. Once it was checked, she said she would file a refund for the dentures and then Sayers’ file would be corrected and he could go to another provider and get dentures there.
We will follow up on this as this case will be examined by the insurance company until Sayers has the dentures he needs.