Lake Wales man told he’ll have to wait 5 more years for dentures already paid for by insurance

Better Call Behnken

LAKE WALES, Fla. (WFLA) – Dave Sayers has been waiting since January to get new dentures 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 few sets of dentures made over the years and I knew darn well, they weren’t even close to fitting,” Sayers said.

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 says he was told to give it a few days and see if it got better. Sayers says the pain only got worse.

“The actual plate itself was so tight that when I bit down, the actual gums themselves, I would have a lot of pain in them,” he said. “I couldn’t even speak with these new plates that they made.”

So he left the dentures with the doctor’s office. He says insurance representatives sent him to another provider for a fitting. But then came more bad news: He was denied coverage. He was told it was because insurance had already paid for the set that didn’t fit.

Sayers was told he’d have to wait five more years. He appealed but was told this week it would be up to 30 days for a decision.

So he knew he’d Better Call Behnken. Investigative Consumer Reporter Shannon Behnken left messages for the insurance company and stopped by the dental office.

A representative from the office called back to say she contacted insurance and had already sent in a corrected claim. Once it is reviewed, she said she would submit a refund for the dentures, and then Sayers’ record would be corrected and he would be able to go to another provider and get dentures there.

We will follow up on this as this case is reviewed by insurance until Sayers has the dentures he needs.

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