Woman kicked in the teeth by horse, fights insurance for dental reconstruction

Woman kicked in the teeth by horse, fights insurance for dental reconstruction

by Lisa Rantala

Living with missing and broken teeth for more than two years, retired Mount Gilead teacher Laura Cleveland called ABC6 On Your Side Problem Solvers in desperate need of help.

“If the horse kicked and my arm flew off, they’d put it back on,” Cleveland told Problem Solver Lisa Rantala while disclosing her insurance policy and plan.

Cleveland’s battle for dental reconstruction started shortly after she said her horse Kahn became startled at feeding and kicked. His hoof made impact on the left side of Cleveland’s face. She fell unconscious and her son called 911.

Cleveland underwent immediate surgery at The Ohio State University Wexner Medical Center in February of 2020 for a broken jaw. She was instructed to return in six to eight weeks to regroup and talk about reconstruction. That’s when Cleveland said her insurance carrier CareSource based out of Dayton started denying her claims.

“I can’t chew. I know my speech has suffered. It only seems to get worse over time,” said Cleveland. “It’d be great to have a pretty smile, again. I did have a pretty smile.”

Cleveland’s policy reads, “We will cover initial dental work that you might need including exams, x-rays and restoration.”

With the potential cost of reconstruction reaching up to $80,000, she filed complaints with the Better Business Bureau and the Ohio Department of Insurance about CareSource’s lack of service.

Last August, the state sent Cleveland its response which states investigators “found evidence that CareSource acted improperly” and “the matter requires further review.” With no specialists in network, CareSource told the state it approved four out-of-network office visits but did not approve procedures like ct scans, bone tests or implants.

Last month, CareSource sent Problem Solvers this statement:

“While we cannot comment on any individual member’s situation, at CareSource, we value our members’ health and well-being and provide enhanced benefits, such as dental care for specific product lines. As a leader in compassionate care, we take all member concerns seriously and work diligently with our dental providers to ensure members’ needs are met within the parameters of their plan.”

 

After Problem Solvers contacted the insurance company, Cleveland said she received a call from its communication team.

More than two years without teeth, she’s now been told CareSource will try to find a specialist in the Columbus area to get her case resolved.

While no a

Appointment has yet been made, Cleveland said she’s now hopeful.

 

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