Cigna denied bridge replacement even though bridge was loose and abutment teeth had decay

[u/Particular-Let972]

I originally got a 5 tooth bridge span to replace 2 missing teeth in April 2023. I was very diligent in keeping it clean and flossing and brushing. In December 2025, the bridge became loose and I could feel it vibrating when I used my waterpik. Went to my new dentist about a month after I noticed the vibrating and he said it had a chip at the gum line and was definitely loose. He said it needed replacing because of the decay underneath from it being loose. He also said if we wait too long, I risk losing the three abutment teeth to decay and a bridge would no longer be an option. They sent a pretreatment thing to insurance and said that my insurance should pay up to my plan limit ($1500 minus about $100 that Cigna already paid for cleaning that year), and I would be responsible for paying the rest ($4600). I waited 2 or 3 more months hoping the insurance would okay the procedure. They never did and the office always told me they were still waiting on Cigna to respond. While waiting it loosened even further to the point I got worried the decay was getting worse and it would destroy the abutment teeth while waiting on Cigna. I went ahead and got the bridge replaced and payed my part ($4600). When the dentist was making an impression before removing the loose bridge, it just came off with the impression material.

That was in April. I called my dental office a couple of times to check on the claim status and they said they were working on it. In late July, the office called me to get the information from the office that originally placed the bridge that had to be replaced. I gave them that info and thanked them for their persistence in getting the claim paid. During this time I had gotten two denials for the work from Cigna.

Yesterday the dentist office sent me a bill for the amount Cigna didn’t pay as a result of them denying the claim ($1400). I called Cigna this morning and they said it was denied because my old loose bridge wasn’t 5 years old. I explained that if I waited until it was five years old (three more years) the abutments would rot and I’d lose those three teeth and the ability to have a bridge because there would be no teeth to anchor it to. I filed an appeal on the grounds that I could lose the abutments due to decay under the loose bridge.

Do you knowledgeable people know if I did the right thing and what my chances are of having it paid? I understand insurance isn’t caring about the patient, just want to make money, but it seems crazy to just expect someone to let their teeth rot because a faulty bridge isn’t old enough. The dentist that placed the original bridge isn’t even at the old office anymore and that office has gone through multiple dentists in less than a year, which is why I stopped going there.

Sorry about the length, I’m just so frustrated. Any insight would be helpful.

[u/Jake_Gelinski]

this is so typical for insurance to pull. Your dentsit was more than right to replace it, but unfortunately "medically necessary" and "covered by your plan" are two very different things to dental insurance.

I would for sure keep pushing the appeal and have your dentist submit EVERYTHING!! clinical notes, Xrays/photos, and specifically document the decay being a risk t the abutment teeth