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Holland Woman Fights Insurance Company For Coverage and Wins

Posted at 7:28 PM, May 14, 2014
and last updated 2014-05-14 22:12:54-04

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.