Are you an individual or family affected by ectodermal dysplasias? It can be a long process to get your claims paid by your health insurance—even though it’s medically necessary care related to a congenital anomaly.

As part of our Insurance Assistance Program, we’ve put together the following series of steps to help you successfully work with your insurance and dental providers to get your claims covered.


Step 1: Contact Your Plan Administrator

Ask them to email you a copy of your actual policy. You can’t fight a denial without your policy. Once you receive your policy, review and highlight what the policy covers and excludes. While on the phone, ask if you are covered under a group health insurance plan, the laws that govern your policy depends upon the state that the policy was sold/issued in, which may be different then the state you live in. 

Pro Tip: When you access a digital copy of your insurance policy use Ctrl F to search for congenital anomalies in the inclusion and/or exclusion criteria sections of your policy. Also, search the words birth defects, congenital disorders, or congenital malformations.

Step 2: Read About Health Insurance Claims

Follow each of the rules in our Navigating Health Insurance Claims resource to learn what you need to know and do to submit health insurance claims for your dental care.


Step 3: Download Our Insurance Toolkit

This toolkit will walk you through in detail the steps you need to take to make a successful claim. It also includes sample letters, diagnosis codes, a list of insurance companies that have granted dental benefits under medical.


Step 4: Download Our Dental Providers Insurance Toolkit

This toolkit is for you to take to your dental office and share with their office staff. It is a step-by-step guide for dental providers to help their patients get health benefits for the dental care of ectodermal dysplasias. It includes common diagnostic codes and letters of support. An administrator from a dental office who has successfully got benefits for all 50 of their patients with ectodermal dysplasias helped us prepare the toolkit. Make sure to share the Providers Insurance page with your provider. 


Step 5: Watch Insurance Webinar

This webinar will walk you through what you need to know to submit health insurance claims for your oral health care. It includes practical tips, information on diagnostic codes and the process you need to take. Please note that not all aspects of this webinar will be relevant to each case. The process may be different for each person, depending on your provider’s claim process. 


Step 6: Contact Our Office

Our staff and advisers can talk to you about the process, answer questions, provide tips for success and more importantly, listen with a compassionate ear. Advisers are individuals in our NFED community who have been successful in the insurance battle. 


You Can Do This!

Follow these steps and you will have the best chance of being successful. It might seem overwhelming but take it step by step. We are here for you if you stumble or have questions.