BETHESDA, Md. (WUSA) -- Seventeen-year-old Miles Hendricks should be playing a much different tune. Earlier this year, he accidently dove teeth first into a goal post.
"I saw my teeth on the ground. And, it felt like my gums were pushed up a lot," Miles says.
His dad, Evan, called his insurance company, United Healthcare, to confirm that Miles' dental accident was covered under their policy.
"I felt pretty good at that point," he says.
Ten months later, his front four are still gone, replaced by a painful, temporary mouthpiece. It's because United refused to pay for implants.
"They clearly say they cover it. But then, they say they won't allow the treatment that will actually allow you to replace lost teeth, and so it's contradictory," says Evan Hendricks.
"The courts will always rule that any ambiguity favors the consumer," says Robert Hunter.
Hunter is the Director of Insurance for the Consumer Federation of America. He says families shouldn't just roll over and take no for an answer.
"I tell consumers, when they have a claim, particularly a big claim, that they have to be prepared to fight," insurance expert says.
The family was now faced with either paying for the $20,000 procedure out of their own pocket or fighting United Healthcare to honor the policy.
We took a look at their policy. Pages 14 and 15 say that "dental services to repair damage caused by accidental injury..." are covered. But, when you flip to pages 50 and 51, the policy excludes "dental implants and bone grafts related to implant placement."
Miles' mom Rosario says, "We pay the insurance $1,600 a month! We have paid many, many years with them, and suddenly, when we need them, they're like oh no, that's not in the paper."
Implants are today, without question, the state of the standard of care and provide by far the best service," says Miles' dentist Eric Foretich.
The Hendricks say United Healthcare wouldn't pay for the implants and didn't give them any other alternatives. So, they took the matter to the insurance commissions in Maryland and the District of Columbia.
"It's crushed me to see that this company is willing to do this to my son. That they would be willing to let him go through his whole life with permanent damage so they can keep an extra $20,000.
After our interview, the Hendricks learned that the DC Insurance Commission sided with them, and ordered United to pay for the procedure.
A representative for the company says, "United Healthcare is following the guidance provided by the Department of Insurance and processing payment to the Hendricks family."
It's a race against time for Miles to finally get his implants. His parents hope other people facing a similar situation know that there is help.
"Read your contract, know your rights, trust your instincts and don't give up," Evan Hendricks says.
Even more good news for Miles, he is scheduled to have the procedure done in early December.
If you end up in a fight with your insurance company theConsumer Federation of America offers the following:
Keep good records
File a complaint with the company at the top
And, check with theNational Association of Insurance Commissioners to see which companies have better claim records.