Posts Tagged ‘ dental ’

So, Emil (as primary on the insurance) gets a bill this week that the dentist wants the rest of the money for the bridge replacement. Insurance didn’t pay their part due to “a pre-existing condition….missing tooth”.

I know this is a big “shock” to you all, but I’m seething. I know “receptionist” (in quotes and lowercase because she can’t actually do that job in a dental office) could see the anger steaming from my ears and darting from my eyes hours later when I marched into the office and demanded an appointment for a Sit Down with the DDS.

1. Before Emil changed jobs we got an estimate for my medically-necessary bridge replacement. It was confusing, so I called for more info. “receptionist” couldn’t help, but after I insisted, she gave me to someone who could print up another copy, look at it with me, and figure it out; even she was confused, at first. It wouldn’t be confusing if insurance wasn’t paying less than the 50%, but because we hit the total annual cap before the third item, it was a clusterfuck of expensive information…for a whopping three line items!
2. Then, Emil changed jobs and had a different open enrollment month, so I requested another estimate. When it was exactly the same as the previous one, I called. “Um, we have new insurance, which is why I needed a second estimate. This seems to be another printout from the insurance we had.” I was told that they all pay 50% so that it would be the same. Really? So then why didn’t you tell me that when I called to request it? Right: “receptionist”. gah!
3. Procedure done. My senses of sight, sound, smell, and touch were stuck in Hell during the procedures. Lots of money paid out of pocket. Lots of bitching and ranting on ye olde blog.
4. Bill for more money….due to the “pre-existing condition” and a claim that they didn’t pull the tooth. Oh, let us flash back to my Senior year of high school when the dental insurance company used that same bullshit on my parents.

Now, unless they are going to call conception a pre-existing condition, their excuse doesn’t hold water. I never had the tooth. It’s hereditary. “Missing Tooth Clause,” my ass.

So, after a meeting, I marched my pissed-off self into the dentist office, fully prepared to make a scene, if necessary. I tell “receptionist” I need a meeting-not-exam with DDS. I told her to be sure he was prepared with all my insurance information and that he needed to be ready to make a decision about how he was going to handle what they messed up. True to her form, she asks, “so you’re already a patient, then?” #facepalm

I get home and call the dental insurance. It’s been one of “those” weeks, so they got my full wrath.

1. After call-processing hell that thinks X and N are the same sound (and after I’m sure my call was flagged for “stressed” by my resounding “NOOOOOO!” when it asked if it “understood correctly”), I started the conversation with, “I need to talk to someone who can make decisions.”
2. I jump through all her hoops; she puts me on hold.
3. 30 minutes later I get a supervisor who makes me start over.
1. Never had the tooth; hereditary thing
2. Got an estimate in June to pre-tax the money to pay our >50% part of the bill
3. They weren’t replacing a tooth; see point #1; they were replacing the previous bridge
4. He then says he can’t do anything and tries to explain the contract they have with the University of Texas–Like.I.Care! I ask for someone who can do something and am told there is no one. I LOL in his ear. Of course there isn’t. But, I give him a full ass-chewing where I repeatedly explain how “no one” can “do anything” and how the process is set up that way just to keep customers from getting what they paid for. I also explain that my DDS is not going to be happy and he might drop the very coverage due to a lack of communication/payment. Then-and-only-then, the insurance guy explains there is an appeal process to him and about three steps up the chain. I get the number and, while fuming, explain that there will be no money paid on this. We didn’t get two estimates for “fun”. If they lied to the DDS, that’s between them and the DDS. We did due diligence on our part and then some. I practically dare him to use the “damage your good credit” line with me in this state.
5. At this point, some of the stuff I said at the beginning of our conversation leaks into his gray matter, “Now, if you were getting a bridge replaced, that would be different.” ACK!

So, he gets the DDS office on the phone. I give him “receptionist”‘s name and tell him to ask for someone else if she answers. Guess what? “receptionist” did the paperwork wrong. Check box #45 is the one she missed. That little box means insurance treated the whole process as if this was a brand new, first-ever bridge that was needed to replace a—-missing tooth. And, we’ve come full circle. I never had that tooth! Furthermore, the paperwork made it seem that the DDS pulled teeth 9 and 11, which isn’t the case. Though they are filed down to the nubs and capped, I still have those teeth.

To be fair to the insurance supervisor, he took all my yelling and ranting–only some of which was because he didn’t listen the first time–in great stride. By the end of the hour-long call, I had what I needed/expected/wanted and was apologizing for feeling the need to be nasty. I explained to him that I’ve had this same fight over every bridge and that I think the entire industry is a racket. Clearly, if I’m still fighting the same battle some 20+ years after my first bridge, the industry still has a lot to learn.

During the drama, I Tweeted a lot of frustrations. I was sad-yet-comforted to know that one friend had the exact same problem. Her dental insurance told her that hereditary missing teeth are a pre-existing condition unless they are diagnosed before 18 months of age? WTF? Why would an 18-month old have dental xrays? Besides, are permanent “buds” even visible yet at that age????

Friday mid-day, I get a call from “insurance” gal at the DDS. She’s just as ignorant as “receptionist”. She said the insurance company called and that they were doing new paper work and wanted to know if I still planned to come in for the Sit  Down with the DDS. I told her that if they know what they are doing to get it corrected and she is confident it will all go through without any further billing to us that I don’t need the Sit Down. She balked immediately and *I* had to explain to *her* that she missed “Checkbox #45″ on the form…and that without that box, insurance thought it was pulled teeth and a new bridge. She’s confused and bewildered and says she can look at it next week when the paperwork arrives. “Yes, you need to look for Checkbox #45 on the form if you want to get paid.” #moron

I know this has consumed a lot of our blog this year, but I go through this whole thing every time this bridge needs to be replaced. Every damn time. Health care is a racket…the whole industry. Dental is among the worst.

To the DDS who tried to convince me that getting all my teeth pulled in favor of dentures was a bad idea,
“Can you hear me, now???!!!?!?!?!“

While the entire healthcare industry is a racket full of it’s own bullshit, I’m going to rant blog today about the dental niche.

The Dental Probrem

We pay for dental “insurance”. Apparently, the morons who designed this system don’t understand how insurance is supposed to work. Insurance is supposed to go like this: everyone pays a little money into a pool. When something goes wrong, the pool pays that person’s bill. It’s not really more complicated than that unless you want to factor in every case detailed in the industry regulations. Rates are figured based on the likelihood of something going wrong. If you live in a Hurricane town, you pay more insurance on your house. If you live in a place with a lot of bad drivers, you pay more insurance on your car. If you smoke, you might find it difficult to get health insurance at all. We all pay a little, some a little more, so there is money to use when bad stuff happens.

When Bad Stuff Happens

Dental insurance, however, just barely covers the cleanings and xrays needed per year. It’s a wash. Fine. But the kicker is when you need work done…and they only cover %50…aaaaannnnnnnd, they cap that! So, someone has to shell out a bunch of c-notes ($1200-1500) when my bridge needs replacing.

Bridge #1) My parents paid for the whole thing. Dental insurance wouldn’t cover it. They claimed my missing tooth was a pre-existing condition. Um, yeah, if you count my great aunt and skip a generation all the way back to Eve. Their “logic” was that they didn’t pull the baby tooth, therefore, they didn’t start the work. Um. I was like 9 when they pulled that tooth. Was that insurance company even in business, then? Maybe. Was my mom a potential customer? Probably not. Dental insurance for teachers in rural Texas would be a luxury back then, I’m sure! WTF?
At the next open enrollment, Mom ripped the insurance rep a new one, dropped all her coverage, and went on Daddy’s insurance with his school district. You see, when she signed up for dental with that dolt, she asked the very question: missing tooth, braces, bridge, etc. And, they paid for the braces including that fancy spring, and the retainer with that fancy fake tooth…so why not the final step? I think it was ~$4000. That’s more than my flute cost….and it’s good for way more than ten years! It’s a bridge, not computer!

Bridge #2) Insurance covered half. I paid $1200 for a beautiful bridge that was improperly installed.

Bridge #3) Insurance covers half up to the cap. Emil paid $1500.

Furthermore, both DDS’s for Bridges #1 and #2 wanted to do implants, instead. Yes, I love the idea of you tying a tooth to my jaw with a wire. And repeating that process every ten years, too! Fortunately/unfortunately insurance didn’t cover that extra expense. So, my first bridge was a pair of veneers along the front of my two good teeth to hold the one false tooth. By Bridge #2, we had to move to caps, so my original (healthy!) teeth had to be ground down even further. Remember, kids, this was all in an effort to keep as many of my own teeth in my head as possible. #fsckrs.

Backstory

You see, here is what adult-Lori would have insisted upon: pull the baby tooth #10 and it’s matching “friend” #7. File down the canines (#6 and #11) so they look like incisors. Pull the additional teeth necessary (if it was seven their way, this way needs four more or six total) to fit my mouth. Use braces to shift the canines and remaining teeth into place. All real teeth…which is what they said they wanted for me. None of the mess or expense. I wasn’t mature enough at nine years old to devise this plan or insist upon it. Or, if the baby tooth was going to be a problem, cap just that tooth. It was nicer than the little subs I have, now!

This—the decision to force me into the pain and expense of a new bridge every decade for the rest of my life…when that could have very well been avoided—is what has me so pissed off!

What We Can Predict

They expect bridges to last about a decade. This is predictable information about my dental future.

Another thing that’s predictable: I’m a 5-month patient. I really need my teeth cleaned every 5 months. Insurance won’t cover you if you schedule a cleaning early. Even if it’s the holidays, they expect you to wait until January instead of sneaking in in November.

Also predictable: a cavity every couple of years. I think I was a real grown-up before my first cavity. I attribute the rise in frequency to two things: new-Army dentist philosophy is “fix it fast” (old-school philosophy was “watch” to see if it will develop into a cavity) and money. They make more money when you are in the chair than when it’s empty!

And a known fact: I take good care of my teeth. I’m not perfect, but I usually get compliments from the hygienist.

Emil gets cavities a little more often (once a year, maybe) and doesn’t floss often, but his teeth aren’t falling out of his head or anything. And, he doesn’t have any “appliances”. I think he might even still have his wisdom teeth.

If we know all these things, can’t the “big insurance computer in the sky” predict what we should pay to cover this and cushion for emergencies, too?

How I Think It Should Work

Granted, this scenario has me (and Emil) paying a little more per month, but it’s what I’d prefer over $1500 “surprises”.

• Cleanings/Xrays: $175 each, every six months for him & every five for me: $770 annually
• Fillings: $140 each, 3 every two years: $210 annually
• Bridge: $3000 each, 1 every ten years: $300 annually
• Emergency: In ~70 years of adult life, let’s just say everyone has one dental emergency that is $1000 (this is where the “insurance computer” could nail this. The industry is about nothing if not averages and predictions.): $2 annually
• Dentures: Again, assuming we live long enough to need them, $3000 each: $7 annually
• TOTAL: $1290 per year, $107 monthly

Now, I take good care of my teeth. Let’s compare that with the “good driver” discounts and say *I* save 10%. $102.09 monthly.

Normal. So, if you’re a “good” dental patient, it might look like this:

• Cleanings/Xrays: $175 each, every six months: $350 annually
• Fillings: $140 each, 1 every three years: $47 annually
• Emergency:  $2 annually
• Dentures: $3000 each: $7 annually
• TOTAL: $406 per year, $34 monthly

Isn’t that a lot easier? On everyone except me/Emil? If I can do this in a blog post, why can’t that part of the Dental Industry get their shit together? Oh, because it’s a racket, that’s why.

Finally, let’s assume that we all pay the number in the middle: Averaging what Emil should pay, what I should pay, and what a good person pays, ~$45 monthly. Hey, now wait a minute…that’s even a little less than what we pay!

See? Racket. #fsckrs.

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To me, a rant doesn’t have to have a solution. When there is a solution to the rant-worthy problem, it’s no longer a “rant” by my definition.

http://www.southparkstudios.com/full-episodes/s12e08-the-china-probrem

I have a bridge. It’s in the front of my mouth. It’s the nemesis to my smile….and a large reason why anyone rarely finds me on “that end” of a lens.

This is the hell I’ve been through…through visit 1 of 2 for my 3rd bridge.

• As a kid, I went to an old-school dentist. He was mean; he did that jerk/pinch thing to my cheek during Novocaine shots. He believed in hiding stuff from his patients. I’m a question-asker; I’m far more comfortable with answers than with mysteries. However, his hygienist, Denise, was really nice and gentle. For for the first few years of my life, I actually liked going to the dentist.
• Denise taught me well, and I took good care of my teeth. They gave me those red pills to chew to show you where you missed when brushing. I flossed most of the time. I did that nasty dental rinse stuff. It was a big waste of time.
• After I lost most of my baby teeth, they did some xrays and found that one of my upper, next-to-front teeth (tooth number 10) didn’t have a permanent “bud” behind it. It’s my dad’s fault. His aunt has the same missing tooth on the other side. Since I’m the collective worst of my parents, it’s no surprise that I got his teeth.
• I had too many teeth in my head, so they were crooked. They decided to pull seven teeth, several of them were permanent teeth. They pulled the baby tooth without the permanent. Remember, he’s old-school?!? He wanted to keep “as many of my real teeth as possible”. WTF? I had several excruciating dental visits where they painfully numbed up an entire side of my jaw and pulled several teeth at once. I bled like a sieve, usually through two batches of cotton packing and down the front of my shirt. #classy
• I had my first braces-spring at ~12 years old. It interfered with my ability to play the flute. Since my mom expected me to be a prodigy, this was a problem. To say it interfered with my social life in the hell known as middle school would be a gross understatement. Since there are no pictures–not that I would post one, anyway–I’ll try to describe this “appliance”. I had braces. Not the cute ones that everyone else had. Yes, every other braces-wearing teen I knew went to the other Orthodontist in Paris.) No. I had the big/ugly braces that my old-school orthodontist (recommended by my old-school dentist) liked. Add to that, a hole in my mouth where a tooth used to be. And not a hole “back there” where someone could only see it if I laughed really hard. No, right up in front and almost-center. Furthermore, to keep my teeth from shifting into the hole they made, I had a spring. Not where the tooth should have been. No. That would be too simple. I had a spring on the wire of the braces. It stuck way out in front. It took me weeks to learn to put my lip back down over it without the use of my hand. I even wore rubber bands when I didn’t have to just to cover up the spring/hole. Did I mention this was middle school? It was terrible.
• Finally, at some point in high school, long after everyone else got the same right of passage, it was time to take the braces off. They left them on me for as long as possible to “train” my teeth into place. I learned to eat ice and chew gum and all the things you aren’t supposed to do with braces. I learned to do this because they were in my mouth for so frackin’ long. Anyway, I got to graduate to a retainer. Joy. At least the spring would be gone. The retainer came with it’s own drama. Of course. Because I had a missing tooth, they put a fake tooth on my retainer. Remember when everyone would put their retainers in the cute little boxes as they sat down to lunch. I couldn’t do that. Nor, could I talk, laugh, or smile at lunch. Because there was a big hole in the front of my teeth. Same story, second verse: I learned how to eat with it in. I only took it out twice a day…to brush it and my teeth. At least, after another learning curve of “now my mouth doesn’t have braces”, I could play the flute better.
• Finally, my Senior year, I whined hard enough (like I had to get my tonsils removed after my Freshman year because my old-school pediatrician decided I would “grow out” of the ear aches and tonsillitis) and they were willing to consider the bridge that had been promised when I was ~9 years old. Mean, old-school dentist was afraid I was not finished growing. At that point, I hadn’t gained any height in years. I was doing growing “up”. Even if I gained an inch or two during college, which is highly unlikely for a girl, how much of that would affect my mouth? Dumbass. He finally gave in and made me a bridge.
• I’m 5’3″ and was a skinny-mini back then. He made a bridge that could have fit Warren Sapp (#theU). It was ridiculous. And the wrong color, too. I had to re-learn how to put my lip back down without my hand…..all over again. I hated it for the whole time I had it. The installation was traumatic. Dr. Old School gave me Novocaine, but nothing else. The sounds, sights, and smells are still haunting.
• Somewhere in between, Daddy got all his teeth pulled. He even apologized to me for not being as sympathetic as he should have been when they took my seven. He was miserable. But, after it all healed, he got a great set of dentures that he loved. His teeth were terrible and our old-school dentist had a new/mean hygienist. Daddy saw her one time and never went back. Thanks to him, I didn’t have to go back to her, either. Mom was unrelenting until Daddy agreed with me. He asked around and found a new dentist in Deport, Texas. He was great. In college, and for the first few years I lived in Bryan, I scheduled my cleanings in July and December so I could go to him. I was his longest-distance patient from both cities.
• The good/bad news is that the damn bridge I hated lasted for 15 18 years, about 5 years past it’s expected life. So, one day when I flossed “through” it, it was both elated and pissed off.
• I visited “the” dentist in Bryan because he’s “new-Army”.  I knew I was in trouble when they offered me a glass of champagne in the waiting room. His plan was a bridge for the entire upper front, so both sides would match. Oh, and he doesn’t take any insurance. Yeah. Right. I laughed my ass out the door.
• Old-school DDS #2 (in Bryan) was a nice man with a lovely staff, at first. He came highly recommended from someone who isn’t supposed to recommend DDS’s, but violated the professional ethics for my unusual case. Turns out, s/he was wrong. OMFG! He was a great guy for cleanings, exams, and x-rays. He was too old-school to give me more than Novocaine , and I was done. And, I loved my new bridge. The Dental Artist in Bryan did a superb job and it was perfect. Turns out, it was installed incorrectly.
• .
  UPDATE:
  Oh and I totally forgot this part first go round: I had an abscess (a cavity on the root of the tooth) and had to have a root canal. Abscesses can be caused by decay (nope) or trauma. The only trauma to the tooth was the installation of the bridge! The Endodontist had to drill through my bridge to repair the abscess. There was a significant risk that he could break the bridge and I’d have had to start all over. Thanks to all the gods and goddesses of every faith ever that didn’t happen! Valium is a fun drug.
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• Furthermore, the DDS took his Porche-choo-choo train to crazy town, his staff left en mass, and his new hygienist was reincarnated as the bitch from my very first dentist. She was so rough on me in my only cleaning with her that I was sore for several days. And, she yelled at me the whole time about what a bad job I was doing of taking care of my teeth. Bullshit. She did such a bang up job that I didn’t see a dentist again for ~2 years.
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  UPDATE:I saw our niece’s friend at a wedding a few months later and asked her what happened. She filled me in and confirmed to me that all the hygienists think his new girl is mean.
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  So, when my current DDS carefully asked, “Who did your bridge?” I defended it, “A Dentist in Bryan and I love it.” The xray showed a cavity forming under it. It was installed incorrectly letting little mouth germies get in there. Damn. Fuck. Fuck Fuck Fuck Fuckity Fuck Fuck Fuck. It’s only been ~4 years since I went through bridge hell!!!
• I had decay under the caps. And, Dr. Old School #2 used so much “glue” that my current DDS had to grind most of off instead of scoring it, removing it, and grinding the residual adhesive. Nice. I guess Dr. Old School #2 wanted it to stay there for 15 18 years, too. #fsckr.
• So, Wednesday night, I took some good drugs and drifted off into la la land where my dreams resembled either Disney’s Fantasia or an acid trip (so I’ve heard) or both. Micky wasn’t there, but everything came in bright colors and repeating patterns. And, I can’t remember any more than that. No wonder so many visual artists take drugs. I could be famous if could replicate that shit.
• Thursday, I took the other pill and Emil drove me to new-Army dentist. First, he filled a molar where an old filling had come out. Then, after, a full hour of grinding on my #9 and #11 teeth, the bridge finally came off. Then, came more grinding for the rest of the adhesive and cleaning for the decay that was forming underneath. Ew. Yes, I made them let me look again. I guess they made a mold for the bridge, but I don’t remember that part.
• Then, my two-hour time slot was up, so my DDS had to leave his assistant to do the temporary bridge. Had it not been temporary, I’d have asked for a discount! j.k. She’s super nice and really good at her job. During the terrible locations for the Novocaine (all the way in the back and up front under my sinus cavities), she patted and stroked my hand and coached me to breathe while tears ran down my temples. Damn that hurt….but she made it hurt just a little less. She should moonlight as a labor coach. I hear that hurts like a bitch! Anyway, she worked and worked on the first bridge, but then gave up and made a new mold. The second one was just about perfect right away. I asked how durable they are. They aren’t good for more than a couple of weeks. And, now, I can tell. It’s “plastic” feeling and catches food easily…and I’m being really careful.
• Emil brought me home. I watched the entire first season of Weeds while he napped. We were both fully alert just in time to watch Mississippi State give LSU a run for their money
  …and I gave a small running commentary on the game.
  
• I go back in a couple of weeks for the “permanent” bridge. I have more drugs, but that installation should be a breeze, by comparison. Hell, even I could probably take this temporary bridge off and clean/prep the stubs.
• Here’s hoping for three things:
• It’s as beautiful as the one they had to grind out,
• they install it correctly, and
• that it lasts as long as the first one did.

I still don’t smile, much. I guess I never had the chance to learn how.

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Aggies say old-army for old-school. It harkens back to their all-military days. So, they say new-Army, too. I don’t think anyone says “new-school”.

“If you aren’t going to give me more than just Novocaine, I’ll find a dentist who will.” and “Yes, dammit, I’m over a grand out of pocket, I am too sure I want to see the hole and the tooth ‘stubs’!”

I lived with the cracked bridge for a while, and we pre-taxed the money during open enrollment. So, I was sitting pretty on an extra ~$1200 in my checking account. They swipe the card. It’s declined. I panic. I call in to check the balance. It’s there (and “accessible”). They try again. Declined. WTF? I call BBVA Compass Bank and learn that their “courtesy” policy is to limit daily spending/cash to $1,000. WTF? Well, I was at the dentist, had the money I owed them, and needed them to authorize the payment. Guess what they can’t do? My DDS had to charge $900 that day and the other $300 the next day. And, I had purchased something that morning, so I couldn’t get cash or pay for dinner that evening, either. #fsckrs. Who the hell are they to tell me how much I can spend in one day? It’s not like it was being spent in Bolivia. No one steals a credit/debit card to spend $1200 at a dentist!