For basically my entire undergraduate career, I did not have health insurance. Because my mom was on Medicare, I obviously couldn't be covered under her plan, nor could I even be considered for Medicaid (some stupid rule about the same household not being allowed to have both Medicare and Medicaid). In other words, I rarely went to the doctor. I took advantage of a community clinic to get my prescription blood pressure medication (kind of important), but other than that, I almost never visited a physician. And I never went to the dentist. I knew I had some issues, but any kind of major procedure just wasn't an option.
Fast-forward to a few weeks ago. If you frequent Top Comments, you probably know more than you ever wanted to know about my mouth woes. No medical professional has thus far been able to fully explain the horrors that were going on in my mouth (including massive swelling, bleeding, and weird tongue issues), but the best guess is that it was mostly a periodontal issue related to my teeth needing a serious cleaning. And when I visited the periodontist, that's exactly what I got: a root planing, or a deep cleaning. Very unpleasant, as you can imagine, but necessary. And I haven't had issues since. Thankfully, now that I'm actually employed and have benefits, I had my awesome dental insurance to fall back on.
Oh, wait...NOT. Follow me below the fold for my tale of dental insurance woe.
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The root planing, without insurance, would have been several hundred dollars. But, fortunately, the periodontist's office checked, and it was a covered procedure under my insurance plan. I still had to pay $140 out of pocket, which hurt, but it wasn't going to break me. And it was a completely necessary procedure. So I shelled out the $140 and got my deep-cleaning.
Fast-forward to yesterday. I'm feeling much better, and I'm flossing a lot more so I won't have to go through that awful procedure ever again, and life was good. And then I went to my mailbox.
I found a letter from my insurance company. Okay, I thought, it must just be a summary of what they covered. I opened it up. Funny...under the "Paid Out" column, there was nothing. Under the "Amount You Owe" column, it said $452.
I must be reading it wrong, I thought. So I decided to give the insurance company a call and ask them to clarify. When I did, a lady very cheerfully told me that, yes, I was reading the statement correctly. My claim was denied, and I would indeed owe $452.
I asked why my claim was denied. After all, the periodontist's office checked on this before they performed the procedure. She told me it was because it didn't qualify. I asked why it didn't qualify. She said that the powers-that-be at the insurance company determined, based on the information the periodontist's office provided, that no root was exposed prior to the procedure. Therefore, I didn't need a root planing.
Nothing like being told by an insurance company representative what I "need" (yeah, I know, that's what they do all the time). I'm pretty sure the two weeks I spent in oral hell would like to have a word with this insurance company.
After going back and forth for a while, I asked to have the periodontist's office brought on the line. The person at the office was just as surprised as I was. She said it was very clear that my root planing would be covered, but the insurance company representative maintained, very (sickeningly) cheerfully, that my root was not exposed, and I therefore was not eligible to receive a root planing.
And that's pretty much where it ended. So now, the periodontist's office (which has been wonderful about this) is submitting a request for reconsideration on my behalf. After that, I have the right to appeal on my own. All of that should take several weeks. But I don't have high hopes for the outcome. For some reason, I don't see the insurance company caving on this. But we'll see. If not, I guess I'll have to add $452 onto my existing medical debt. I'm starting to wonder why I'm even paying my insurance premiums.