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Parma Heights couple living with insurance coverage nightmare

Parma Heights couple lives with an insurance coverage nightmare
Posted at 10:16 PM, Mar 26, 2021
and last updated 2021-03-27 13:04:51-04

PARMA HEIGHTS, Ohio — Ralph Tescar of Parma Heights wants everyone to know how difficult it is to live without back teeth.

The 62-year-old U.S. Postal worker said that a battle over who will provide insurance coverage for the teeth he lost in a December 2016 traffic accident has, in many cases, left him without the ability to eat a normal meal.

Tescar said his truck was broadsided by a driver who ran a stop sign, causing serious facial injuries.

"I was coming back from a Christmas visit and a girl ran a stop sign," Tescar said. “It pushed my truck into a curb and into a tree, and literally flipped it on its side. The air bags went off, which propelled my hand into my face, breaking several teeth.”

Tescar said Medical Mutual of Ohio agreed to fully cover five dental implants and paid for the needed surgery and implant posts. But he said when he switched coverage to Blue Cross Blue Shield just before his dentist was going to install his new teeth, both insurance companies denied coverage.

Tescar and his wife Lori Lee told News 5 there is no way they can come up with the $12,000 to $20,000 out-of-pocket to pay for the teeth so, in some cases, Ralph and wife are using a blender to prepare meals.

“It’s been extremely hard, picture not being able to eat a steak in the summer, or trying to eat spaghetti with just your front teeth." Tescar said. “I never thought this would go on this far, because I actually got approval from Medical Mutual. I’m in between, I’ve got nobody that will pick up the ball and run with it. I was told I was no longer covered and nothing could be done. And I spent time with Blue Cross and got the same thing, first promises that it would be taken care of, but the bottom line is they would not take care of it.”

Tescar said he's filed complaints against both insurance companies with the Ohio Department of Insurance and the Ohio Attorney General's office.

News 5 contacted Medical Mutual of Ohio about this case and it issued the following statement:

Medical Mutual, like any other carrier, would not have provided coverage for services that occurred after termination from our plan, even when services are approved prior to termination.

The health benefits available to employees of the United States Post Office (USPS) are provided by the federal government’s Federal Employees Health Benefit (FEHB) plan and are not separately administered by the USPS. All federal employees, including postal employees, have the option each year to choose from a variety of health plans administered by several different carriers. Mr. Tescar chose to change plans from Medical Mutual to the FEHB Blue Cross Blue Shield option during the 2018 “open season” period. The Post Office did not switch from Medical Mutual to Blue Cross.

We do not believe there would be any basis for another FEHB plan option to deny benefits as a pre-existing condition. HIPAA prohibits group health plans from excluding pre-existing conditions.

    News 5 also contacted Blue Cross Blue Shield of Ohio and it's now agreed to reopen Tescar's case. The insurance company issued the following statement in response to our story:

    Our team is researching the case and will reach out to Mr. Tescar tonight to let him know the review is taking place, and to provide him a direct point of contact as the case progresses. We can clarify that the original denial was not due to a pre-existing condition determination.

    News 5 will continue to follow-up on this developing story.

    Meanwhile, the Ohio Department of Insurance told News 5 there are resources for Ohioans who are having difficulties with insurance coverage.

    Consumers with insurance questions or concerns can contact the Ohio Department of Insurance at 1-800-686-1526, or file complaint usingits complaint center, or go to its website.