Life

Sorry, Fighting Dental Insurance Just Isn’t for Me

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I received a pair of letters about my dental insurance earlier this month. But the result wasn’t what at least one sender hoped for.

When you receive a letter that begins, “I made a very difficult decision,” you know you’re not going to like it. I received two letters in the same week about my dental insurance. The first came from the provider. My dentist’s office sent the second.

But the one that should have made me angry isn’t the one that did.

I found the first letter, from my insurance provider, to be very matter-of-fact in tone. Right off the top, in the first line, it told me that as of June 30, my dentist would no longer be in their network.

From there, it went on to suggest a convenient option to find another in-network dentist. That way, I could continue to receive the benefit of their full coverage for my dental health needs. It gave me the sales pitch about how much it cares and wants to make sure I’m getting the most for my money. Marketing.

A few days later, I received the second one. It was a doozy.

It started with that “very difficult decision” part. Then it went into a diatribe about my insurance provider, which it states “has become increasingly difficult to work with.”

They impose a massive administrative burden on my practice, and we often need to do battle with them to pay even the most routine claims. Over the years, it has become noticeably clear to me and my team that [Company] has no interest in your oral health.

Oof! I told you it was a doozy!

The office’s letter goes on to say they made the decision because if they were to stay in the network, they would “not be able to provide the highest quality of dental care” or “provide the safest possible environment.”

My health, they say, is “too important” to ever compromise. Marketing.

But hey, don’t worry, the letter says. In many cases, there’s no difference in what dental insurance covers for in-network and out-of-network dental work. Maybe that’s true, but it seems suspicious to me. They’ll still submit my claims, which is something the letter from the insurance company hinted wouldn’t be an option.

They have an “in-office membership plan” that can also help. Marketing.

So if everything is so rosy, what, exactly is all the drama about?

It doesn’t take a rocket scientist to read between the lines. The biggest thing that’s going to change — which didn’t appear in that letter — is that when it’s time to “do battle” over a claim, that fight will be mine, not my dentist’s office’s.

I get it. If the insurance company is such a pain in the ass for them, they no longer want to waste the time and effort. That’s reasonable.

But I don’t have the time or energy to take up that battle myself.

Because I allowed an extreme fear of dentists (because of a childhood experience) to keep me from going for many years, I now require more frequent visits. Oh, the irony.

I am certain — because it already happened with an “in-network” provider — that my insurance coverage doesn’t fully pay for those more frequent visits. I am reasonably certain that coverage allowance would be even less out of network. I’ll borrow one more line from that matter-of-fact insurance letter:

This costs more.

As for the “in-house office membership,” does anyone think that’s free? Honestly, if that’s enough to solve my problems, why didn’t I already know about it? Why didn’t I already know there was this much of a problem rather than finding out after it’s too late.

Loyalty is an important quality to me.

The letter from my dentist is the one that really ticked me off. The one from the insurance company should have been the one to anger me. The notion that I’d just up and jump shift because a provider was leaving an insurance company’s network should be offensive.

But I found a manipulative tone in the letter from my dentist’s office. It was as if they were berating me for picking such a confrontational insurance company. Here’s a hint: I didn’t pick my dental insurance. I never had a menu of insurance companies to choose from. My choice was, literally, “Dental insurance: Take it or leave it.”

I didn’t get to say who it was with. I didn’t get to say which dentists were in-network. And I certainly don’t get to decide what it does and doesn’t cover.

While I like my dentist and the staff, this is a period of extreme inflation. I can’t exactly afford to pay more. While I’m at it, let me also add that this dentist is 30 minutes away. I’m sure you’ve heard gas prices have gone from too high to astronomical.

I don’t like being disloyal. That really does bother me. Maybe I’m one of the few people who are still brand-loyal out there.

I feel guilty for switching dentists. I found one I like on my side of town and have already made the first appointment. (He’s in-network and they don’t seem to have the same constant battles, from what they tell me.)

I feel guilty as if I’m cheating on my dentist.

But then I feel guilty for feeling guilty.

I’m being put in the middle for a battle that I had absolutely no part in starting.

That letter probably wasn’t supposed to have that effect. But it did, and that’s the worst part of it all.

Have you ever faced a medical provider leaving your insurance network? Did you stay with them? If not, what would it have taken for you to stay…and potentially pay more?

the authorPatrick
Patrick is a Christian with more than 30 years experience in professional writing, producing and marketing. His professional background also includes social media, reporting for broadcast television and the web, directing, videography and photography. He enjoys getting to know people over coffee and spending time with his dog.

3 Comments

  • Zero. You end up paying a lot more for out-of-network coverage.
    I have observed what usually happens is that they are denied a particular treatment such as electrolysis where a woman can have it paid for because it is labeled as Hirsutism but for us it was denied. It took a case before the Commission on Human Rights and Opportunity to get it covered. (The ruling is here “https://www.glad.org/wp-content/uploads/2020/04/Dec-Rule_04152020.pdf” and I filed an amicus curiae brief for the case.)
    What I have seen is that the healthcare provider (I use healthcare provider instead of doctor because now a days you are just as likely to get a PA or APRN as a MD. My endo who is a APRN slaps my hand each time I say doctor when I am on a panel with her. We do a lot of training together.) charges their agreed upon in-network rates and not what they charge normally charge for the procedure and the insurance company pays their standard rate. While for an out-of-network healthcare provider charges full rate and the insurance company pays a percentage of that fee. For example, a procedure is $2000 for an in-network patient and the insurance company has negotiated a rate for the procedure of $1000 and you end up paying $200 and the insurance company pays $800. For an out-of-network healthcare provider the healthcare provider charges $2000 and the insurance company pays $700 and you pay $1300. And there is usually a but… Sometimes the healthcare provider make you pay up front so you have to pay the $2000 and then you get a check for $700 from the insurance provider, usually six or seven months later.
    The deck is stacked against us.
    I worry that if something happens to me at my cottage on the Cape because it will be out-of-network and from what I read it is a 50 minute ambulance drive (over 40 miles) to the nearest hospital will cost $10,000! They Life Starred a traffic accident victim to the hospital one time and the newspaper article said they charged $150,000 for the out-of-network flight.

  • I counsel people on getting insurance coverage for surgery and other healthcare coverage. I say when you call up the insurance company that if you get turned down, hang up wait a minute and call back to get another operator. About half the time that works. Repeat if necessary.
    After that they have to go through the appeals process if they get turned down. If that doesn’t work I have them call the state Office of the Healthcare Advocate.
    The favorite word for the insurance companies is “No.”

    • Glad you said that, Diana. So let me ask you: How many times have you found it to be the case that a patient pays the SAME money out-of-network as they did in-network without having to take on any added responsibility of fighting the insurance company for reimbursement that an in-network provider would otherwise handle?

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