Back in 2006, 7-year-old Victoria Crovo hit a bump while sledding and went flying. She came down face-first on a patch of bare pavement on a dead-end street near her house in Melrose.
The crash landing drove her upper front teeth into the bone above her lip. Last month, 11 years after her horrible accident and now old enough to have expensive implant surgery, the college freshman sat down in a dentist’s chair for the last of dozens of grueling procedures, some lasting four hours.
Victoria’s parents have had separate medical and dental insurance policies for 25 years, since before their three kids were born. But insurance paid only a small fraction of the more than $20,000 in dental bills for Victoria.
Their dental insurer, MetLife, paid the maximum allowable under the policy — barely a couple thousand dollars. Lisa and Steve Crovo then turned to UnitedHealthcare, their medical insurer, to pay the balance, which is allowed for some kinds of dental work needed because of an accident.
UnitedHealthcare rejected their claim.
One of the country’s largest medical insurers, it cited a policy clause that cuts off coverage for dental services within a year of an accident — long before Victoria could have the surgery because her teeth and mouth were still growing.In addition, UnitedHealthcare, like other insurers, usually does not cover implants, which Victoria ultimately required.
“This is going to be on us,” Lisa Crovo remembers saying to her husband with a mixture of dread and resignation, after being handed a $10,100 bill from one of Victoria’s dentists. By then, Crovo had been engaged in a yearslong losing battle with UnitedHealthcare, an experience she likened to some of the procedures her daughter had endured but with far less satisfactory results.
I consulted with half a dozen experts in health insurance. They said there is no good reason for excluding Victoria’s dental work from medical coverage.
David Lustbader, a dentist and president of the Massachusetts Dental Society, said the gap in insurance coverage for injuries like Victoria’s “isn’t fair to the family or the child.”
“Should it be covered? Yes. But is the insurance company on firm legal ground to deny it? Probably,” he said. “You can argue that’s stupid, but the insurance companies are very strong, and I don’t think they are going to yield.”
Simon Bernstein, one of the dentists who treated Victoria, said insurance companies should offer coverage for highly complex — and highly expensive — restorative dental care, though those policies would probably come with hefty premiums. And they would come too late for such families as the Crovos, whose daughter’s injured teeth would be considered a preexisting condition.
“What’s needed is greater cohesiveness between dental and medical insurers,” he said.
UnitedHealthcare responded to my inquiries with a brief statement citing its 12-month limitation on accident-related dental coverage. Its insurance is meant to cover urgent or emergency dental care, the company said.
Victoria’s dentists thought from the beginning that she would lose her teeth eventually, but they took extraordinary steps to stabilize them and keep the roots alive while she was a little girl. Bernstein said it was obvious she would need expensive implants, which are porcelain substitutes for teeth, screwed into the bone.
But implants are not for young children. As a child matures, her face changes; teeth that fit at age 8 don’t fit at 18, Bernstein said. A child’s mouth and teeth are “a moving target” for dentists, he said.
Steve and Lisa Crovo had to refinance their home to pay for their daughter’s lengthy treatment.
“It took a long time for us as a family to get over that day when Victoria came screaming into the house, a bloody mess,” Lisa Crovo said. “But we did.”
Getting over how the family’s insurer treated them, Crovo said, might never happen.
“It’s just so frustrating,” she said. “We’re not trying to take advantage of anyone. We’re not trying to get something not due to us. We’ve paid premiums all these years for insurance. But when we need it, it’s not there.”
Wendy Mariner, a professor of health law at the Boston University School of Public Health, sketched a brief history of medical and dental insurance for me. Medical insurance, she said, was developed decades ago to cover extraordinary, unpredictable expenses in the event of something catastrophic, like a diagnosis of cancer, or serious injuries from an accident.
Dental insurance developed on its own, apart from medical insurance, in the 1970s, with coverage caps that haven’t changed much in decades.
Anthony Turiano is a family practice doctor in Andover. He is also Lisa Crovo’s brother.
“It’s just not right,” Turiano said of UnitedHealthcare’s denial of Crovo’s claim. “The insurance company is using a rule that doesn’t make sense” to save money, he said.
When UnitedHealth denied Crovo’s final appeal, Turiano told his sister to e-mail me.
“How do I feel about refinancing? Not great,” Lisa Crovo told me, sitting in a kitchen that needs painting. (Steve is doing it, slowly.) “But we had no choice. We had to have the work done for Victoria, and done right.”
Victoria is the third of the Crovos’ children to enroll at the University of Massachusetts Amherst; their son graduated with an engineering degree, and their older daughter is studying biochemistry.
Victoria was captain of her high school volleyball team and league MVP. Last summer, she coached two teams of middle school girls in volleyball, in addition to her job walking dogs (“I just love all animals and want to be a veterinarian”) and cleaning tables at Fresco’s, a roast beef and seafood takeout place in Malden.
Victoria said she loves her implants — no more hiding her smile because of crooked and discolored teeth. And something else that’s different: Victoria recently bit into a corn on the cob, for the first time since the accident.
“It really tasted good,” she said.Sean P. Murphy can be reached at firstname.lastname@example.org. Follow him on Twitter @spmurphyboston.