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-> Lakewood, Toms River & Jackson related Inquiries
amother
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 Tue, Sep 17 2024, 10:45 am
I’m wondering if I should switch my plan?
My older kids had their braces covered under United healthcare and going to Dr krug.
Although dr krug is still accepting United healthcare, he says that United is not really covering braces.
Should I switch my hmo ? Should I switch to a different orthodontist?
Please tell me your experience and opinion.
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amother
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Tue, Sep 17 2024, 10:47 am
Switching HMO's is not going to help you. They are all under the same Liberty Dental Plan.
Can you try submitting your own appeal once the request for auth from the ortho gets denied? I tried that and BH got approved. But my child's teeth were pretty bad (jaw issues, overbite etc) . it wasn't just basics....
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amother
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Tue, Sep 17 2024, 10:51 am
| amother Sage wrote: | Switching HMO's is not going to help you. They are all under the same Liberty Dental Plan.
Can you try submitting your own appeal once the request for auth from the ortho gets denied? I tried that and BH got approved. But my child's teeth were pretty bad (jaw issues, overbite etc) . it wasn't just basics.... |
What do you mean? You wrote a letter?
What did you write?
Yes, for one of my children it’s pretty severe.
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amother
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Tue, Sep 17 2024, 10:54 am
| amother Sage wrote: | Switching HMO's is not going to help you. They are all under the same Liberty Dental Plan.
Can you try submitting your own appeal once the request for auth from the ortho gets denied? I tried that and BH got approved. But my child's teeth were pretty bad (jaw issues, overbite etc) . it wasn't just basics.... |
I done think united is under liberty
Amerigroup fidelis and Aetna is
I just got approved with amerigroup bh
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amother
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Tue, Sep 17 2024, 10:56 am
| amother Nasturtium wrote: | I done think united is under liberty
Amerigroup fidelis and Aetna is
I just got approved with amerigroup bh |
Which orthodontist?
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amother
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Tue, Sep 17 2024, 10:58 am
Basically dr. Krug doesn’t want insurance to cover it because he makes more money if you pay out of pocket. It’s all how you fill out the form so they fill it out in a way that instance won’t accept it. I tried to appeal my case and dr. Krug had to send in photos and he made my daughters case not as severe as it was. So he’s if the doctor would word it correctly it would
Be approved but they see everyone is agreeing to pay out of pocket so why should they take insurance.
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amother
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Tue, Sep 17 2024, 10:59 am
| amother OP wrote: | What do you mean? You wrote a letter?
What did you write?
Yes, for one of my children it’s pretty severe. |
I didn't end up writing them. I called them up to request an appeal on my own (separate from the ortho office's appeal) I had a phone conversation with a rep and they then sent my child's file to an outside dentist for review and ultimately they approved him. BH
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amother
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Tue, Sep 17 2024, 10:59 am
| amother Antiquewhite wrote: | Basically dr. Krug doesn’t want insurance to cover it because he makes more money if you pay out of pocket. It’s all how you fill out the form so they fill it out in a way that instance won’t accept it. I tried to appeal my case and dr. Krug had to send in photos and he made my daughters case not as severe as it was. So he’s if the doctor would word it correctly it would
Be approved but they see everyone is agreeing to pay out of pocket so why should they take insurance. |
I don't know about this. my friend just got approved for her child with Krug. But don't know which HMO she had...
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amother
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Tue, Sep 17 2024, 11:02 am
| amother Antiquewhite wrote: | Basically dr. Krug doesn’t want insurance to cover it because he makes more money if you pay out of pocket. It’s all how you fill out the form so they fill it out in a way that instance won’t accept it. I tried to appeal my case and dr. Krug had to send in photos and he made my daughters case not as severe as it was. So he’s if the doctor would word it correctly it would
Be approved but they see everyone is agreeing to pay out of pocket so why should they take insurance. |
I got approved by them on the first try. It all depends if ot is a cosmetic issue or not.
Many people come to Krug to try insurance but go elsewhere if they aren’t approved. (Someone who is the same price but doesn’t take Jersey care since they are paying anyway)
So I don’t think that is what he does.
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amother
Tangerine
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Tue, Sep 17 2024, 11:04 am
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Ds wasn't approved on amerigroup 3 times between Krug and Friedman and appealed it to and denied. For now I'm waiting because I can't afford it. Ds main issue is missing an adult tooth
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amother
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Tue, Sep 17 2024, 11:07 am
| amother Tangerine wrote: | | Ds wasn't approved on amerigroup 3 times between Krug and Friedman and appealed it to and denied. For now I'm waiting because I can't afford it. Ds main issue is missing an adult tooth |
missing a tooth doesn't sound like an issue enough to get them to approve:(
I had 3 siblings with this issue and none of them got approved for coverage.
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sweetdimples
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Tue, Sep 17 2024, 11:16 am
| amother Antiquewhite wrote: | Basically dr. Krug doesn’t want insurance to cover it because he makes more money if you pay out of pocket. It’s all how you fill out the form so they fill it out in a way that instance won’t accept it. I tried to appeal my case and dr. Krug had to send in photos and he made my daughters case not as severe as it was. So he’s if the doctor would word it correctly it would
Be approved but they see everyone is agreeing to pay out of pocket so why should they take insurance. |
I think your speculations are unkind.
OP, it is generally hard to get NJ care approval for orthodontics. My daughter had an impacted tooth and the doctor said he will send in the necessary paperwork but it will most likely be approved, and she BH was.
Dr. Krug for reference
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amother
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Tue, Sep 17 2024, 11:18 am
| amother Nasturtium wrote: | I got approved by them on the first try. It all depends if ot is a cosmetic issue or not.
Many people come to Krug to try insurance but go elsewhere if they aren’t approved. (Someone who is the same price but doesn’t take Jersey care since they are paying anyway)
So I don’t think that is what he does. |
Just curious, why would they go elsewhere?
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amother
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Tue, Sep 17 2024, 11:24 am
Shorter wait times.
Location closer to them
Thinking that a dr that doesn’t accept Jersey Care is a better dr.
Or maybe they found a better dr…
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amother
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Tue, Sep 17 2024, 11:41 am
| amother Sage wrote: | | I didn't end up writing them. I called them up to request an appeal on my own (separate from the ortho office's appeal) I had a phone conversation with a rep and they then sent my child's file to an outside dentist for review and ultimately they approved him. BH |
Thank you for explaining what you did.
Which hmo was it?
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amother
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Tue, Sep 17 2024, 11:58 am
| amother OP wrote: | Thank you for explaining what you did.
Which hmo was it? |
aetna
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amother
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Tue, Sep 17 2024, 12:03 pm
| amother Nasturtium wrote: | I got approved by them on the first try. It all depends if ot is a cosmetic issue or not.
Many people come to Krug to try insurance but go elsewhere if they aren’t approved. (Someone who is the same price but doesn’t take Jersey care since they are paying anyway)
So I don’t think that is what he does. |
My daughters case should have been approved when I didn’t I went to another orthodontist who was a lot better if I’m paying out of pocket at least use a better doctor. Dr. Krug is a Jersey care doctor for free it’s not worth it to pay to use him.
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amother
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Tue, Sep 17 2024, 12:21 pm
| amother Antiquewhite wrote: | | My daughters case should have been approved when I didn’t I went to another orthodontist who was a lot better if I’m paying out of pocket at least use a better doctor. Dr. Krug is a Jersey care doctor for free it’s not worth it to pay to use him. |
Why isn’t dr krug a good orthodontist?
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amother
Maroon
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Tue, Sep 17 2024, 12:54 pm
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He's a fine orthodontist. The fact that he accepts jersey care doesn't change his abilities. I don't know why the other poster is badmouthing him.
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