I just spent the last 45 minutes on the phone arguing with a dental insurance representative. Gee, that makes for an afternoon of rainbows. :)
Ok - here's the situation...remember about a month back, John and I were concerned about a 'spot' on Katie's tooth. I called the dentist and they suggested to bring her in and they would take a quick look to see what it was. Turned out to be a small surface cavity just beginning, so they fixed it. They also found another 'spot' that was just beginning to decay so you couldn't see it just yet, but they suggested we get that fixed as well. And then they would apply a sealant to the tooth to make sure it was protected even further. The whole process took 2 visits - about 15-20 minutes each. And because we had caught them so early, they didn't even have to use Novocaine.
Fast forward to now - we get the bill. The total the dentist charged was $517. Let me say that again....$517. That's 2 filings, an x-ray, and a sealant. Our insurance paid a whopping $123.00. Our balance is $358.00. (The difference of $36 was reduced because we used an in network provider - whatever.) There was an office visit of $60 - insurance company wouldn't pay that because she had just been in a month ago for a checkup, and they only allow for 2 visits a year, no emergency visits.
"Ok, if she was just in a month ago - why the HELL didn't the dentist see the cavity?"
"I don't know ma'am."
Then there were the x-rays....the insurance covered those....thankfully. The sealant? Nope, insurance says no way, Jose. We didn't need Novocaine...but Katie did use the nitrous oxide. Insurance doesn't pay for that at all. When I used the 'gas' 2 years ago, it was $25. This dentist charged me $50 for Katie....each time. You can't tell me that a 35 pound little girl uses more gas than I do.
The filings - the dentist charged $274.00 for those tiny teeth. Insurance is supposed to pay 50%...did they? No. They paid $87. Leaving us with $187. The insurance company claimed that they will only pay 50% on mercury fillings...these were amalgam fillings - they cost more. Here in Minnesota, it's very difficult to find a dentist that will do mercury fillings on a child. Our dentist is no different, we didn't have a choice in material.
Because we were concerned for Katie's teeth - we took her to the Dr. I asked the insurance rep if it would have been better off for us to wait 5 months to bring Katie to the dentist - wait for her 6 month checkup. That way the tooth would have decayed even MORE to the point where they would have had to use Novocaine. The Novocaine would have been covered and the office visit would have been covered. And perhaps Katie would have been in pain and not as excited about the dentist anymore. The rep apologized saying that she realized the system isn't perfect, but this is the coverage that is contracted, blah, blah, blah.
This sure didn't make any sense to me. And I don't think there's any quick fix to correct it either.
5 comments:
Will you go over this with the dental office too? They might reduce it a bit.
M.
I'll give it a try next week, but I don't think it's likely. They have explained the charges over the phone and sent me three seperate bills in the last month. They want their MONEY!
Welcome to my world :) This happens all the time -- dental insurance is probably the worst! You just have to ask yourself if it was worth it to you in the end! Just be thankful she didn't need to have any pulled -- although that probably would have been cheaper. This is probably the down side to living in the cities -- will cost you more. I always felt the sealant was a worthwile expense for Sarah and never agrued about that. Now Wally goes every 3 months so two of his visits are never covered at all, but he had periodontal disease and this helps prevent bigger problems... so the cost is probably worth it. I hate to tell you it will only get worse..and you probably have a max benefit amount per year. Ours is $1000 per person and Wally comes close to that EVERY year!
Denise
My Dental insurance for the boys when they were little under 12 would pay for the fillings now if they need them the insurance will not pay because they are adults, but get this, when I need a filling insurance pays, does not make any sense to me, I take the boys to one in Lacrosse out of network, and mine is in Prairie in network, but it is still a screwed up mess. So I totally understand.
Janet
Speaking of yearly maximum's. Ours was 2k, and we hit it for both heather and I last year.. and heather already has it planned for this year. :(
Maybe try to talk to the dentist to see if they can give u an estimate. Our dentist (besides charging us an arm and leg too), atleast tells us (after talking to the ins company) what to expect from the bills, and tells us how we can save... (like wait till the next year, or only have 1 xray per visit, as they don't cover 2 (even though they are different types.)
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