My usually decent gub'mint benefits are lousy when it comes to dental work. I've shelled out big over the past couple of years for visits to my pre-job-change dentist, mostly because I like him and he comes from a really nice family that gives generously in the community and he doesn't pressure me with lots of expensive tooth-whitening treatments like so many dentists seem to these days. A couple of months ago, he told me to get some gum work done, as it seems my years-old gum grafts are again receding.
He referred me to a periodontist (let's call him Dr. Gummy), who was disturbingly young and a tad too flirty, but seemed competent and nice and didn't try to push any excess procedures on me. The work he recommended would run about $500 out of my pocket, after insurance, or so he said. I provided my insurance information when I arrived, and both the doc and his staff assured me that they had numerous patients with my coverage. The procedure was scheduled for next week.
Imagine my surprise, then, when I opened my mail yesterday to find an Explanation Of Benefits from my insurance company informing me that exactly none of the procedure would be covered, and that Dr. Gummy is not even on their provider list. Frustrated and concerned, I called the insurance company, which confirmed that there was no way in hell they were covering the grafts unless I used a preferred provider. Then I called Dr. Gummy's office.
The receptionist was as placid and pleasant and disengaged as can be, and we had one of those conversations-with-service-people that left me wondering whether the words leaving my mouth were actually reverberating off of her eardrums:
Me: Yes, hi, I'm scheduled to have some grafts done next week with Dr. Gummy, and my insurance company just informed me that they won't cover a penny of it.
Her: Oh, well, do you want to reschedule?
Me: Um, no, I'm trying to figure out what's happened here. When I came in for the initial consultation, Dr. Gummy told me that you had several patients on my insurance, and you gave me a sheet with the estimate for my portion of the bill. Now the insurance company is telling me that Dr. Gummy isn't even on their provider list, and that they won't pay a penny.
Her: Do you have the sheet we gave you with our estimate of your cost, or would you like me to fax you over a copy?
Me: I have it here. It says that my share would be less than $500, which is fine, because I've got some flexplan money available, but the total bill is over $2400, and I can't afford that. Now my insurance company is saying they won't pay any of it.
Her: So you don't want to have the procedure done?
Me: Well, I really need to have it done. Dr. Gummy told me the recessions should be dealt with as soon as possible, and that was two months ago. But my insurance company won't cover it.
Her: Oh, OK. We offer a 5 percent discount when there's no insurance coverage.
Me: I don't think you understand -- I can't afford this. I was told to expect to pay no more than $500, and even with a 5 percent discount, I'm looking at a couple thousand dollars here.
Her: Well then, I'll go ahead and cancel your appointment.
Me: But I really need to have these grafts done. Dr. Gummy said they were pretty urgent. I've basically lost two months because you guys told me that my insurance, for which you had all the information, would provide substantial coverage.
Her: We do offer a discount when there's no insurance coverage.
Me: I can't afford the procedure without insurance coverage. Do you think maybe Dr. Gummy could give me a referral to someone who is covered by my insurance?
Her: You can just give that sheet to the other doctor and it will tell him what work you need done.
Me: No, no, I don't have another doctor. I was hoping I could get a referral to another doctor.
Her: Just give them the sheet we gave you.
Me: Forget it.
Her (cheerily): Did you want to cancel that appointment?
I hung up the phone feeling like I'd just stepped out of the old What We Say/What Dogs Hear Far Side cartoon. And I still need to find a new periodontist.
I can relate to your current problem. Have had various types of dental work of the type you describe. What I want to relate though, is slightly different from what you experienced but still a very frustrating experience. My son Alex needed to have what was called an extra tooth removed and it was not covered on any of our health or dental insurances. My DDS recommended an oral surgeon so I went to that appointment. I noticed the degrees posted on the wall, etc, etc,. We entered into the agreement stage and I said, I must go into the room with Alex prior to the surgery while you explain to him what is going on for a couple of reasons, he is young, never had surgery before, and is hard of hearing. Surgeon said no way, my policy is not to allow anyone else other than the patient into the surgery room. I said, ok, give me my deposit back I am finding another surgeon. After some searching, I found another oral surgeon who was great and allowed not only me, but Alex' dad in the room and we left after Alex was put under the anesthetic. So keep trying!!!!! Best of luck as I know how difficult it can be to do anything like this and feel like you are spinning in the air..... Sheila
Posted by: Sheila | June 03, 2004 at 09:33 PM
Hello there. You must remember in these situations, whether dental or medical, there is only a relationship between you and your insurance provider. The doctor or dentist only works with the insurance companies as a courtesy, and it is in fact this courtesy which actually can add significant expense to office overhead. It is also important to note that patients that do not have insurance end up subsidizing the care provided to patients with insurance because of this. If your provider does not elect to cover treatment necessary for your health, your anger should be directed not at your periodontist, who only wishes to provide the care you need, but at your insurance carrier.
Posted by: Suresh | April 24, 2005 at 01:37 PM
What exactly did you expect the receptionist to do? Let you have the procedure and not bill you mor ethan $500?
Come on lady?!?
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