What a Life!

Our dear sweet Joey has reached the Age of Opinion. He doesn’t generally cry because things “aren’t right” in general anymore. No, he cries because he doesn’t like something specific that is happening.

Case in point: the other night Steve came home from work and I wanted to fix supper. The logical plan was for him to hold Joey while I worked in the kitchen. His diaper didn’t need to be changed, and he wasn’t due for another feeding (based on his typical schedule) for another half hour or so. Steve took him and sat down. Joey took one look at him and started screaming hysterically. You know, the they-left-me-on-the-side-of-the-road-and-drove-off-without-me cry. He’d cry like that for about a minute and then he’d stop. He’d look at Steve, and then he’d start screaming hysterically again. “You are not the person who is supposed to be holding me. I want my Mommy!” Finally, after about five minutes of that, I gave up on the idea of fixing a meal (who needs to eat anyway?) and took Joey back, at which point he immediately stopped crying and was quite content.

Yes, I know Joey loves me. He’ll still say Da-da before he says Ma-ma, though. Steve had to work and work with Ben to get him to say Mama. The trick that finally worked? It had to be part of a song. So they’d go around the house together singing “Mommy. Mommy.” Oh my!

Speaking of opinions, I have one of my own. Yesterday Steve went to the dentist for a regular exam, and they found a tooth that has a filling that is leaking and needs to be replaced. Since Joey was born less than 90 days ago, we still have the option of changing our coverage and Steve asked me to look into it. So I started digging around only to discover that our beloved dentist is not “in network” for the dental insurance plan that we have.

Now with this particular insurance, the coverage is the same whether you are out-of-network or in-network. The only difference is that if your dentist charges $150 for a procedure and the insurance only “allows” $100 for the procedure, you’re stuck paying the extra $50. So I called the insurance to see if I could find out what the allowable charge was for the best-case and worst-case procedures that Steve needed to have done.

Oh, well, they couldn’t give me that information. They could only tell me the percentage of the allowable charge that they could pay. I told them, 80% of $75 for a $150 bill is completely different than 80% of $150. I need to know 80% of what. The customer service rep insisted that she could not give me that information and so I asked for a supervisor.

The supervisor informed me that by asking “80% of what?” I was asking them to break some federal anti-trust law that protects them from having to give out that information. Because…if they gave out that information, then dentists would adjust their fees in order to receive the maximum benefit allowed.

Now let’s be honest here: When is the last time you got a statement from your insurance company where the amount the doctor charged was less than the amount the insurance was willing to pay? Personally, I cannot think of a single instance where that has been true. In fact, I’ve called insurance companies many times before a procedure was done in order to find out what they pay for that particular procedure and thus what our portion was going to be with that particular provider. I mean, it’s only fair that I can find out that information, especially in the case of an out-of-network provider, so that I can make an informed decision regarding whether or not I want the procedure to be performed and who I want to have do it.

According to our dentist’s office, every other insurer that they deal with gives them a list of allowable charges for every procedure. That way they can make an informed decision as to whether or not they want to accept that insurance, and when they do accept that insurance, they know how much they will be paid. How is it that these other companies aren’t breaking this federal anti-trust law by doing that but Dingbat Dental Insurance Company that we’re dealing with is?

Quite frankly, if they do not disclose how much they are going to pay, how are we to know that they aren’t using the dentist’s middle initial to make that decision? Your dentist’s middle initial is K so we’re going to allow $100 for the procedure. His dentists’ middle initial is P so we’ll allow $125 for him. Really…who’s to say they aren’t doing something like that? Gracious!

So I stuck to my guns. I insisted that they give me a firm number as to what they were going to be paying 80% of. It’s only reasonable. I was on the phone for over twenty minutes with that supervisor, most of it on hold. Turns out, she called the dentist office, got the same information from them that I had given her (billing code for the procedure, how much they charge, and so forth), and she finally was able to give me an answer.

I called our dentist back after I got off the phone with the insurance company to let them know what I had managed to find out. The gal I talked to told me that was more information than she had ever been able to get out of that insurance company, and in fact, they had hung up on her more than once when she had tried to get that same type of information for a customer.

Since I used to work for an insurance company myself, I know all about compliance works, including how much trouble it is to document how a case was handled when the insurance commissioner forwards you a letter of complaint that they received from one of your customers. It may have taken twenty minutes of my time to get the answer I needed, but Dingbat Dental Insurance Company may be spending more time on this issue before we’re done. If nothing else, I can return them the favor and cause them a little bit of extra trouble. Just saying is all…