Tuesday, August 11, 2009

...makes the world go 'round

Sometimes the learning bit is the hardest part. Well, that and asking the questions you know will confuse the worker bees. As reported yesterday, I had an appointment this morning to have a couple of fillings replaced after my dentist told me during my last cleaning that they were getting a bit tired and should probably be redone; it’s probably been 15-20 years since I’ve had a filling. “Sounds like a top-drawer idea,” I said to him and I made the appointment to come back after vacation and get all gussied up, dentally speaking. A few things popped into my head last night that gave me pause as I headed to bed last night: the first was the dental guard situation (see my previous work here and here), and the second was X’s incident with the boys’ fillings. A quick review of the fillings is pretty simple – the boys ended up getting a number of fillings amongst them and the bill came to an uncovered number around $1,000. The problem is two fold and has been created by both the insurance companies (Delta Dental for the boys and the Tricare Retiree Plan for me, both of which are similar) and the dentists. Fillings can be dicey since the insurance basically covers amalgam fillings but not the resin composite option that most dentists seem to prefer. In X’s situation there wasn’t any pre-work talk from the dentist about the type of filling and/or whether or not it was covered. I don’t necessarily expect the office to know the ins-and-outs of every plan but if there are filling types that often enough aren’t covered then they should point that out, pre-drill. I decided to ask the office manager about cost and coverage when I signed in this morning; I might as well have walked in with a pig on a leash based upon the confusion I caused. My position was this: I’m cool with amalgam since I’m not a supermodel and I don’t really want to come out of my appointment, walk to the counter to pay my share, and hear the number $500. I have 80% coverage on amalgam (my 20% would run about $80-$100) so I wanted her to give me confirmation of the type of filling and the billable amount to me. Twenty minutes passed before she said they don’t do amalgam but there is some talk in my coverage (which I’d already read) that allowed for an adjustable rate for the composite resin. In either case, she couldn’t actually tell me how much two fillings would cost me before getting the work done. I’ve also found out that filling replacements, in general, aren’t covered in any circumstance unless it involves the structure of the tooth. The end result was that I wasn’t interested in a procedure with no cost associated, especially something as simple as a filling or two. What she finally put forth was a novel idea that they send a pre-authorization request to my insurance who will then respond to both of us with covered costs which allows both of us to understand my payment before the work is done. Her final attempt at “mysterious procedures and billing” involved letting me know that it can take up to three weeks for a pre-auth to come back from the company. I told her that was fine with me since I figured the difference between the $100 I think I should pay and the $500 sticker shock was worth the wait. I have my own ideas of how an office manager should run the place but apparently it’s too hard for anyone else to understand….sort of like turning from your lane to you lane when you’re driving.

I’ll keep you updated.

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