I have been managing dental practices in the Chicagoland area for more than 33 years. Guardian has denied more claims for crown restorations and "deep cleanings" (aka periodontal scaling & root planing) than any other carrier I have ever dealt with. It appears that they have a standard policy of denying the former unless a tooth has had root canal therapy or upwards of 80% or more of the tooth structure is gone. And they will always deny claims for the latter procedure unless a patient's teeth are ready to fall out. Their requirements for deep cleanings to be covered are ridiculously stringent and outdated; their denials always violate the current norms of the American Academy of Periodontology. I have worked for practices where I have been brought on almost exclusively to appeal Guardian claim denials. Additionally, their response to my requests for claim review usually consist of a copy of the original EOB with an additional disclaimer that is always the same pro forma declaration that repeats the original denial reason with no other reasoning for their decision being provided. It is only when I have followed up these appeal denials with a formal complaint to state insurance regulators or involve the sponsoring employer's plan administrators that I have received a more comprehensive document delineating in detail why their alleged "dental consultant" upheld the decision to not pay benefits for legitimately rendered dental treatment. Guardian denies procedures that 99% of all other dental insurance carriers will cover. And this has been the situation for the more than 3 decades I have been submitting dental claims. This carrier is incorrigible, unethical and unrepentantly malfeasant in how they refuse to pay out benefits that their subscribers and we dental providers are rightfully owed.
Claim your business profile now and gain access to all features and respond to customer reviews.
The Guardian Life Insurance Company of America (Guardian), a Fortune 300 company, is one of the countrys leading mutual insurers.