Tuesday, November 16, 2010

More Insurance Frustrations

Dentist - Faroe IslandsImage via Wikipedia
A few weeks ago, I posted a story about some of the frustrations that we have been having with our health insurance and some of their policies in covering some of my son's prescriptions.  Now, it looks like we are about to have another round of fighting with an insurance company, this time with our dental health provider.

I have mentioned before that we recently were able to get our son into a special residential school program where he has been since last Monday.  One of the things we needed to get done before he could attend was to have a dental exam.  I knew it would be tough to get my son to cooperate for a dental exam, but we called several dentists in our plan and found one that said they could deal with his disability.

We went to the dentist, and sure enough, my son decided to act out.  When it finally dawned on him that we were there at the office for him, he dropped to the floor.  We tried all of our tricks to get him up and in the chair, and after about 10 minutes succeeded.  He managed to cooperate for a basic exam.  However, when it came time to try to get dental x-rays, we lost him.  The dentist felt like he had a good enough exam to fill out the form for the school.

According to our dental plan documents, oral exams are supposed to be covered at 100% without any deductible, so we were not expecting any out of pocket costs.  Today, I received an email from the dental insurance saying that the claim for my son's trip to the dentist had been processed.  When I looked at the claim, I discovered that the policy applied a deductible and only covered 80% of the cost after the deductible.

Needless to say, I called the insurance company.  Since the dentist was unable to do a comprehensive exam with x-rays and a cleaning, they coded the claim form as a limited oral exam.  Even though the plan documents say that oral exams are covered at 100%, they say that since it wasn't a complete exam, they only cover 80% after the deductible.  Now I have to hope that the dentist will resubmit the claim with a different code so that it will be covered.

Like the situation with my son's prescriptions that the health insurance would not cover, I am confused by my dental insurance company and their refusal to cover the charges.  If the dentist had done more work, they would have covered it at 100%, thus costing them even more money.  Since the plan documents simply say oral exams are covered, what difference should it make whether it was a complete or limited exam?  It just doesn't seem logical to my way of thinking.  
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  1. If you can make sense out of anything that insurance companies do, you are ahead of me.

  2. I think I have given up on trying to make sense of it



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