Dental Insurance Doesn’t Have to Be So Difficult
A funny thing happened when I went to the mailbox yesterday, but at least I ended up having the last word in a dental insurance debacle.
The other day, I ran across a Facebook post involving patient dissatisfaction with dental bills and dental insurance. Someone who was clearly either a dentist of a hygienist was clearly taking things a bit too personally in her defense of her chosen field.
But even she acknowledged that dental insurance doesn’t work the same way regular medical insurance does.
And therein lies some of the trouble.
About two months ago, days before I had my wisdom teeth out, I had a brief battle between my oral surgeon and my dental insurance company.
It wasn’t over the upcoming procedure itself, but over the pre-surgery exam I was to have leading up to the surgery.
The oral surgeon’s office staff called me to tell me I’d have to pay $70 for the initial exam because I’d already had two consults this calendar year.
I immediately protested that, since I’d never had dental surgery in my life, and, therefore, had never had a dental surgery consult before.
That led to a battle between the dental office and my dental insurance.
I won’t bore you with the long, drawn-out details culled from multiple phone calls back and forth, but here, in a nutshell is what I learned in this little debate:
The insurance company claimed the oral surgeon uses the “wrong” code for a surgical consult, and so it looks like I’ve had the two visits I’m entitled to in the calendar year when I was going to the oral surgeon for a different procedure that would be covered if the surgeon’s office used the right code. The insurance company first suggested that I have the office call them and they could give them the proper code. Then they suggested that the office fill out their portion of the form, give to me, and then I call them for the right code.
The oral surgeon’s office staff claimed the insurance company doesn’t get to dictate to them which code they use and they use that same code with everyone. They refused to call the insurance company, claiming that it would be “insurance fraud” if they used a different code.
I disputed that, asking how it could be “insurance fraud” if the insurance company is the one advising a medical office how to properly – at least from the insurance company’s perspective — fill out a claim that goes to them so that everyone gets properly paid and/or reimbursed. They couldn’t give a satisfactory answer there.
So I paid this $70 for the consult, which consisted of the surgeon, who I liked a lot, peeking in my mouth for less than five seconds — literally, just a quick peek — and then us chatting for about 10 minutes about what the surgery and recovery would be like.
The surgery, it turns out, went far better than I expected. But I still resented being forced to play middle man between the surgeon’s ofice and the insurance company, both of whom argued whether I actually owed that $70 or not. Frankly, I was stressed out enough before the surgery that I shouldn’t have had to join their skirmish.
But after all the rigamarole with the insurance issue, I found in my mailbox a check in the amount of $69.60. (The oral surgeon’s office, for some reason, must have really needed that 40¢.)
I resisted the temptation to call the office’s claims manager and ask why, after all the debate, I could possibly receive this money they were so certain I owed them.
But I didn’t. In the end, I won the debate anyway.
Sometimes, you have to take your victories where you find them!