Pre-existing Condition, My Ass

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

One thought on “Pre-existing Condition, My Ass

  1. Dentistry straddles a fine line between necessary-health-service and bullshit-racket-out-to-get-all-your-money. I haven’t been in two years and my cap is in DESPERATE need of replacement…but I’m terrified to go in. We had a great dentist growing up who was a small-town-service-in-the-big-city(suburb)…and the last time I had a problem a friend’s brother fixed it and made everything lovely, but we’ve fallen out of touch in the last 4 years and he’s not on UT insurance.

    I’m terrified of what’s coming because I spent all year doing infertility – which is not covered at all by insurance. It’s expensive, but it’s so. much. easier. to fix problems or errors.

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