Of EOBs, lying dentists and cheap insurance companies

We never used to hear from our health insurance company, but now they send me mail regularly. Apparently it's now state law that every time they refuse to pay 100% of what the doc bills them for, they have to send an Explanation of Benefits (EOB) to me so that I can see what the original amount billed was versus how much they actually paid. When the health insurance does that I simply file the paper in the trash (after recovering from being gobsmacked that the doc charged $132 for putting some freezy stuff on DS's verruca/plantar wart - a 10 second item that suddenly turned into outpatient surgery on the bill!) However, when the dental insurance company sends me an EOB, I pay closer attention because in that case I have to pay the difference between the amount originally billed and what the insurance paid :-(

I lived for years in the US without dental insurance. Many employers simply don't offer it, or it is so expensive it's not worth it. When I finally had a job that offered dental insurance and decided to sign us up for it, I was advised to look for a dentist that was already cooperating with that insurance plan, or to find one who was prepared to do so. If we go to a 'plan dentist', routine visits are covered 100%. If we go to a non-plan dentist, routine visits are covered 100%. So what's the difference? Either way, the insurance reimburses the dentist what they believe to be reasonable rates for the service. Unfortunately, that is usually significantly less than the dentist actually charges. (Hmm - can you spell NHS?) If you see a plan dentist, they have agreed not to bill you for the difference. A non-plan dentist, on the other hand will bill you for whatever they don't get from the insurance company. And if you need any treatment other than routine checkups and cleanings, the non-plan dentist's work is only partially covered.

My dentist back then would not sign up with the insurance company we had because their reimbursement rates are too low. (Just like the dentist I used to see in the UK, who no longer does any NHS work!) I continued to go there because I liked the dentist. I called once to make an appointment because I had a lump on the inside of my cheek. Although usually it takes months to get appointments, the dentist agreed to see me the same day. In fact he gave me the last appointment of the day - at 8 o'clock in the evening! I was there until after 9 o'clock even though it turned out to be a minor problem that the dentist was able to resolve quite easily. When he told me what the cost was, I almost fainted! As he was a non-plan dentist, I would be responsible for 50% of the charge. I pointed out that had I gone to see my doctor instead and been referred to an oral surgeon, it would have cost me a lot less. His solution: to bill the insurance company for a more involved procedure, let me make just the $10 copay I would have made to my doctor, and so long as the insurance company paid him a specific dollar amount he guaranteed he would not bill me for the difference! Although I was grateful, I was really rather taken aback that he was so quick to offer to lie!

We are currently receiving mail on a regular basis from both our medical and dental insurance companies. The children's routine dental care is covered by our medical insurance, and fillings and so on are covered (at least partially) by the dental insurance. Right now the two companies are arguing about who is the 'primary' insurer, and who's going to pay what. Fortunately, before I got too worked up about it, I noticed that the letters I've been getting are actually only cc'd to me, and it is up to the dentist's office to sort it all out. I suppose that's part of what their insane charges are supposed to cover in the first place so I'm going to let them earn their money!

When it comes time to deal with the orthodontist I'm sure it'll be easier. That's because the coverage for orthodonture is, and probably always will be, simple to calculate no matter which dentist we see - ZERO!

BTW, unless something remarkable happens this year to inspire me, you'll have to consider this my Halloween post, as I've already blogged about Halloween here, here and here.