You Have to Look Out for Yourself!

Last Updated on February 5, 2022

You have to be willing to look out for yourself in this life.

There’s only one court show I’d ever watch, if I were ever in the mood to watch a court show, and it’d be Judge Judy.

What I like about her is that she’s quickly able to sort through all of the palaver to catch the little detail that sinks a story.

One of her favorite catch phrases, and one I’ve found to be quite valid goes like this:

If it doesn’t make sense, it isn’t true.

I experienced a perfect example of this fact of life this week after a trip to the dentist. I had noticed — and my bank account had also noticed — the bills had been getting progressively higher at a rate that did not match any slight increases that might have come from the dentist’s office itself. I’m a periodontal patient, which means I’m seen a bit more often than the standard every-6-month cycle most people are in.

In short, when I inquired of the office staff why the balance was so high, I was told my insurance company hadn’t paid a claim for the entire year of 2015. The amounts they should have paid during each visit passed the $200 mark.

Naturally, I called my insurance company, which promptly transferred me to the wrong department. I’m convinced they do things like that hoping someone will become so aggravated that they’ll just hang up in frustration.

I don’t play that way.

When I finally was transferred to the right person, I explained that I had a printout from my dentist’s office showing that my insurance company had continually rejected claims for 2015. The attendant looked up my account and then said they never received a claim in 2015.

If it doesn’t make sense, it isn’t true.

I pointed out that this couldn’t be true. I had an appointment on August 28 that listed the services performed, the cost and the estimated insurance payment expected. Then on September 14, there was a payment notification from the insurance company that showed they were paying $0.

“Unless your insurance company randomly sends $0 checks to dentists around the country for no reason whatsoever, you had to have received a claim. You can’t reject a claim until you first receive it.”

There’s a great moment of satisfaction that can occur when you defeat an argument with common sense and simple logic delivered in a calm tone instead of with name-calling and profanity delivered with shouting. That great moment is known as the “pregnant pause.” 

It’s the moment when the customer service representative, who has no doubt been well-trained on ways to quickly resolve a dispute, whenever possible in the company’s favor, has his or her script of standard answers derailed.

To put it another way, it’s the moment even the representative realizes, “If it doesn’t makes sense, it isn’t true.”

She asked for my dentist office’s number and then put me on hold. After a couple of minutes, she was back, acknowledging what we both already knew: the dentist’s office had after all, been filing claims as they always had. It’s just that they didn’t file any claims last year with my contract number. They filed by social security number instead.

Nothing had changed, I knew, between 2014 and 2015: if they had this mysterious “contract” number in 2014, they should have had it in 2015. In any case, the rep told me, the office staff now had my contract number and were already in the process of refiling the claim.

After thanking her, I called my dentist’s office and spoke to the office manager who told me something else I already knew: the way they filed claims in 2015 was the same way they’d filed in 2014 and 2013. They always filed by social security number and the insurance company always paid.

It was only in 2015 that they suddenly started rejecting claims. And apparently, it was too much trouble for either a human being or a computer to note anywhere on the claim that they needed the contract number to process the claim. That little piece of information, it seems, would have made things entirely too easy.

It would have made too much sense.

The little situation reminded me of a basic fact of life: no one is going to look out for your interests better than you will. You have to look out for yourself.

There may be exceptions to this basic fact of life, particularly if you’ve been ruled medically or mentally unable to make decisions for yourself.

But for the rest of us, we have to make sure every i is dotted and every t crossed on our own.