• 17Nov

    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!
      [Side note, I picked up both one of these. Apparently, they’ve never heard of email!]
    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 [me] 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. [Really, why do they make the first person collect information?]
      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 [really? we’ve been on the phone for nearly an hour before you mention this little nugget of info?]. It goes through a fax [a facsimile? Really? In 2011?] 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–[drum roll]–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. [No email? Are you stuck in the stone ages? What the hell?]

    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???!!!?!?!?!

  • 16Sep

    While the entire healthcare industry is a racket full of it’s own bullshit, I’m going to rant blog [1] today about the dental niche.

    The Dental Probrem[2]

    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.


    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.


    [1] 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.

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

  • 06Dec

    Another rant so soon? Yes, it seems these things come in waves. Furthermore, there have been several things going on.

    In all kinds of ways, I give a LOT to my community. I give time/skill/talent to charity and other community efforts. I pick up random trash I see. I take a shopping cart from the parking lot into the store. I truly strive to leave every place better than I found it. When asked, I freely give advice for business or charity or just whatever experience I’ve had. I connect people to one another all the time when I see that they have a reason to trade contact info. Etc. Ad Nauseam. Et. Al. Dammit. I don’t want to stop doing these things. I don’t want to have to hold certain information as “proprietary” or “client-only”. Unlike to most only children, I like to share.

    I’ve been told I’m a giver. I guess that fits more times than not. Still, at several points in my life, I’ve been faced with no-tit-for-tat. I have never claimed a need for things to be equally balanced. In fact, close friends will tell you that I frequently give more than I expect to receive.

    Still, I need for there to be some balance. After all, Themis can hold unbalanced scales only to a certain point before she topples over. I need to be rewarded for my hard work/knowledge/etc. in some small manner. Just give credit where credit is due.

    Themis, the goddess of law and justice, with her scales, sword, and blindfold.

    Themis, the goddess of law and justice, with her scales and sword.

    Lately, I’ve given, given, and given. And I’m sad to say that I haven’t been fairly acknowledged when the circumstances called for it.

    • There was one charity who failed to recognize my donation. Even as I was taking photographs of the leader thanking all the other sponsor vendors, she left me out. Just about the time I was going to give up on them, they gave me props and then some. They earned their way back into my good graces with some serious publicity for As You Wish.
    • Our new neighbors like to slam (not close, not shut, but SLAM!) their door 20+ times a day. Even whey they all leave together (we have NO IDEA how many are living in that 2 bedroom unit), they slam the door at least once per person.
      In addition, some resident dog owners aren’t picking up their dog’s poop. One lady even lets her dogs run around unleashed and unsupervised. Really? Read your lease! I am now helping a friend with the occasional dog walk. I will rat you out if I catch you.
      If I can pick up the wind-blown trash around here, they can at least make the effort to close the door (instead of slamming it) and pick up their “canine bowl movements”.
      [Bonus points for anyone who caught that movie reference.]
    • Someone who learned a lot from me through a volunteer experience misused that knowledge. Now, while this would normally not be a thing (we all learn from each other; we all take ideas and tweak them to our liking), the friends we have in common know where she learned this stuff. Again, not a problem…until she professed fact to some mis-information that could make me look inept. This is annoying because she even requested donations from me. I couldn’t honor her request, but spent a decent amount of time trading info with her about exactly how to do what she wanted. Um, don’t use me as your “expert” if you are going to go against the mission of the group and cause infighting. Several years experience taught me a thing or two.
      Reminds me of another time when …
    • I turned down a recurring event in part because my generous donation was not given the credit it deserved. Can you believe they asked me again two times (I politely declined the first request, but received another) to donate? What what? Oh, it gets better. Someone else posted my photos on their own blog without any reference to me what-so-ever. I guess if the original poster had credited me, the other blogger might have seen fit to follow suit, but since [original poster] didn’t, neither did [that other blogger]. Le sigh. No more freebies for anyone in that circle of influence. Meanwhile, several of that same group are patting each other on the back in a public manner. pshaw! THEY asked ME, remember? I didn’t offer my services only to find them underutilized from a lack of fit. This morning, the 2nd offender sent a note asking if they were my photos and did I want credit. Um, yes. Thankfully, she immediately gave me lovely credit. And anyone wonders why I frame and watermark most of my images? Le sigh, again.
    Toppled Themis

    Themis has been toppled. No, she's not tipsy!

    One of my scales is full. I’m going to wait until the flies and dung beetles eat some of the shit off them before I let any more pile up. Don’t make me use that sword!