Dental Fees and Expensive Insurance Goofs

I hadn't been to the dentist in a while so when I got dental insurance at my current job I scheduled an appointment with a dentist office near my office. I asked on the phone if they take Delta Dental and their answer was yes.

The first appointment for my annual cleaning (covered at 100%, in theory) went as well as I expected. I was pressured into spending $25 for this newfangled technology to scan my gums to see if I have gum cancer (which in hindsight I shouldn't have agreed to -- I don't smoke and there are plenty other kinds of cancer I'm at high risk for that I'm not spending money on getting screened for) and the dentist told me I needed to get a full deep cleaning (root planning and scaling) and that she wanted to fill in my back teeth (about 6 of them) so that they wouldn't get worse in the dark spots.

After spending too many years avoiding the dentist (mostly due to not having insurance) I agreed to all of these procedures. I've been to a few dentists in my life and didn't trust any of them, but I liked this office and other than the pitch for the cancer screening, I felt like I could trust this doctor.

I gave the woman in charge of billing and the front desk my insurance card for Delta Dental. I'm not sure if the card says "Premier" on it or not, but at the time neither her nor I noticed it. Besides, Dental Dental Premier sounds fancier than Dental Dental PPO. Wouldn't you think, logically, that Premier means better coverage, not worse than PPO?

The billing lady gave me an estimation of how much I'd owe with the insurance paying up to my deductible. And it wasn't cheap. It looked like I was going to be spending about $2000 with the insurance to get all of this work done. Well, $2025 with the stupid cancer screening.

I figured it was worth it to spend the money now and get my teeth squeaky clean and filled and healthy. I went through all the deep cleanings and paid for my estimated portion at the time of service on my credit card (hey, at least I'll get some miles out of this.)

So today when I went in to start the fillings the normal billing lady wasn't there and an assistant came in to the room to tell me what work I was getting done. Assuming nothing had changed billing wise, I just asked about why I was getting all four teeth on one side done and wouldn't it make sense to get the four worst (the back teeth) on both sides done first. I asked if the billing lady would be in and she was apparently at lunch and would be back in a minute...

This is when I was hit with the bad news. My "Premier" insurance actually didn't cover this dentist office. Well, it did a little bit, but at a much lesser amount than a dentist on the Premier plan. And, apparently I owed $500 to the dentist just to cover all the work done thus far.

I was shocked and felt like crying. It's not that the $500 is going to kill me, but I'm just frustrated that the billing assistant didn't notice that. In fact I remember the first day I came in she was having a conversation with another new patient about Delta Premier but I wasn't really listening to it and didn't know that was the kind of insurance I had... I figured she would tell me if I didn't have the right kind of insurance for that office. So maybe she didn't know or maybe she just missed it. I certainly missed it.

Sitting in the dentist chair today with a bib already around my neck and the dentist walking in the room prepping to do the fillings, I had to get my head wrapped around the $500 that I owed and the more than $600 that the work today would have cost for just four of the eight fillings I "need." The billing manager woman seemed to think I was going to stay and get the work done, basically pitching that I have more of my yearly deductible left so it makes sense to get the work done now before the year is over. I couldn't do all the math and without knowing how much the costs were going to be, I had to get out of the chair and cancel my appointment. It was really awkward and anxiety-causing. I felt like my head was going to explode but I just got up, paid the $500 I owed them, got an itemized receipt of all my work done, cancelled all future appointments and left.

It IS my fault that I didn't understand the Delta Premier situation and how it's different from the Delta PPO I had at my last job. I also didn't really pay attention to the mail I've been getting from Delta because I assumed I paid everything at the time of service... I had been paying more than $200 each time I went in and it was adding up fast.

Now I just wonder if I should bother trying to get fillings at another dentist that's actually on my plan. It still won't be cheap and I had budgeted for the dentist office's estimated costs. I didn't think they'd be $500 more just for a deep cleaning. I don't even understand this itemized bill... what should have been covered if I went to a Premier provider versus what wasn't. I thought the original cleaning and basic xrays were free with the insurance, but it looks like they weren't. I have no idea what I paid for or if I should have or what should be covered by my insurance. No freaking idea. This is really making me, well, not happy at all. I spent more than $1000 this month on medical expenses (incl. doc, vision and dental) and I haven't even gotten my fillings done. I give up. I am just going to avoid the dentist in the future. I'll stick to toothbrushes and floss.

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Yet Another Example of the Fucked Up Health Insurance System

Thanks to Gawker blog The Consumerist for pointing me to the latest news about why the health insurance system, especially for self-employed individuals, is broken in so many ways.

"Cancer Patient Wins $9 Million From HealthNet in Arbitration Settlement."

The LA Times has more details. Basically the woman was lied to while signing up for her policy, and then dropped as soon as HealthNet could cancel her "fairly" with their corrupt and unclear policies.

When HealthNet signed her up, this is apparently what happened...

"When asked about her weight, she told him her weight on her driver's license was 185lbs. She never told Torrez to change the weight, nor was she aware that the weight had been changed."

So... when this woman ended up getting breast cancer, they used the fact that she "gained" weight in order to bump her from the policy. Except, she hadn't gained weight at all. The person who filled out her form while signing her up changed her weight so she would be accepted.

All of this hits close to home for me. While I (luckily) do not have breast cancer or any illness like that, I do fear my health insurance policy being canceled if I ever have to use it. That seems kind of ridiculous, doesn't it?

As many of you remember, I had to lie on my health insurance application to get accepted.

My health insurance agent basically told me in so many words that my best option was to lie. He wouldn't go on record about that, but he said my odds of getting health insurance while being completely honest about my pre-existing conditions (polycystic ovary sydnrome/irregular periods and major depression) were slim to none.

And he was right. The first time I applied through Pacific Care, I was entirely honest. My health insurance agent filled out the form for me as I told him my details by phone. Later, when I reviewed the information he entered before signing the form, I noticed he had taken some creative license in describing my conditions. I tweaked the language so it was 100% accurate.

A few weeks later I was declined coverage. Not for depression, which we both thought would be what held me back, but for the "irregular periods."

As my fellow personal finance bloggers LuluGal and Escape Broklyn can attest, "irregular periods" are fairly common. And, to be fair, irregular periods often cost the insurance companies lots of money. Both those two gals are getting surgery for their problems. And, from what I understand, insurance is paying for a lot of the surgery, even though it won't be covering everything.

For me... I don't know if I'll ever need surgery for my various ovarian problems. Because I know about the problems and because I've been diagnosed with PCOS, the cheapest way to maintain my health is to take birth control pills on a regular basis. Except my catastrophic health insurance does not cover medication. So I don't take any.

Ultimately I was approved for health insurance. I had to lie to get approved. Well, I left off the depression and kept on the irregular periods bit. So now I can lose my coverage if they ever realize I lied about depression, and anything health problems I might have that relate to polycystic ovary syndrome won't be covered anyway. This leaves me wondering why I bother with health insurance at all!

I really hope that Obama or Clinton get elected and then make some major progress in getting the health insurance companies in check. While I hate paying taxes, if I'm going to pay taxes I want them to be going towards keeping people in this country healthy... not fighting some trillion dollar war we can't win.

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When Paying Late = Saving Money

I set this afternoon aside to organize all of my late bills and pay off what I can. My auto insurance bill was two payments behind (out of sheer laziness on my part). So I called up and requested to pay it off. It turned out they had my wrong address down, and then when they found out I moved (closer to work) I was told that I could get a discount for driving a shorter distance each year.

So I'm saving something like $100 a year just for calling up because I was late paying my bill. Also, I found out if I pay online w/ auto pay (which I was planning on signing up for anyway, it just wasn't working because they had my old zip code down), I can save $50 a year. Sweet.

I'm still probably paying too much because I have full comprehensive coverage in case my car gets broken into again and I have to get the window repaired. After having it broken into two without the full comprehensive coverage I signed up for it, and low and behold it got broken into again and I got it fixed for "free."

Meanwhile I just paid off my dermatologist bill and put my medical claim filings into an envelope to be sent out. Now I just have to get my health insurance set up on auto pay and I'm set... as long as I have enough $$$ in my checking account. I'm keeping it fairly low, which is scary for me. I usually keep a few thousand dollars in savings with free overdraft in case I overdraw my checking. I refuse to let myself rack up credit card bills, so I use my debit card for just about everything. That kind of sucks when my bank account runs dry, but otherwise works quite nicely.

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Health Insurance Hell -- And I thought this part of the saga was over!

In 2006, I was covered under COBRA. My father was paying the bills to help me get started out after college, and he paid those bills on time until I got my first full-time job with health benefits.

During the time I had COBRA through Highmark Blue Cross Blue Shield, I went to see a gynecologist for a standard yearly exam. She had me get bloodwork done at the local lab. I filled out all the appropriate paperwork and thought I'd owe a small co-pay and that would be the end of it.

Two years later, I'm still dealing with this never-ending drama of trying to get health insurance to pay this bill. There is absolutely no logical reason why they should not pay the full amount (minus a co-pay), but I've been harassed by J & L Teamworks (a collection agency) on and off since my appointment, saying I owe about $1000. What???

Finally, after speaking on the phone to about 20 billion people, I thought I had everything settled in November. I wanted to be done with the mess for good, so I walked into the billing office of Mills Peninsula Hospital, where the lab services were done and apparently where the gynecologist bills her visits through if they haven't been paid on time (they weren't paid on time because they billed the wrong insurance and/or because my address (which I updated on my account by sending in a hand-written letter as requested) was added to my account incorrectly.) I'm still unclear what actually happened. All I know is I started getting calls from the collection agency, and they've barely stopped since.

In Nov of 07, I really thought the saga was over. I fixed my address on my account, I walked into the hospital's billing office and spoke with a nice woman who promised me that everything would be fixed. She even called the collection agency while I was there and said they won't be bothering me again... that they have to wait 30 days before legally being able to call me, and by then everything should be processed.

Fast forward those 30 days and without fail, those calls started up again. I didn't want to deal with it. I was hoping it would all clear if I just ignored it. Of course, that never works.

So today I called J & L Teamworks. They told me that insurance paid for about $200 of the entire bill, but I still owe something like $700.

That doesn't make any sense! If insurance paid for any of it, why are they only paying $200? I would understand if this was one of my newer insurances, but this was full COBRA of the policy I had since I was a kid. They couldn't even knock me for pre-existing conditions, had this been something that they might have got out of paying that way. But this was for a routine gynecological exam and bloodwork. I was on a PPO. My father paid something like $230 a month to keep me on it. I know I was covered. And that bill should be paid.

Of course since I live on the West Coast now and all of my records are back East, I have to deal with the time difference when calling. So it's too late to give a call to Highmark today. I'll have to call first thing in the morning and find out why the fuck this didn't get paid.

What really pisses me off is that I've racked up about $200 in interest on these bills... part of it is my fault because I did at times want to just ignore it because I knew insurance should cover the bill... but othertimes I was told by different people that it was all taken care of, then a month would go by, or two months, and then I'd find out it hadn't processed. Or it only partially processed.

All of my trouble with health insurance makes me kind of glad that I'm finally on a high deductible plan. It's nice to have the safety net (costing $1350 a year) in case I get into a major accident or something, but otherwise I'll just pay for everything that I need to do out of my pocket. I'm a little worried about how expensive that will all be... but I figure if I check out the services offered by Planned Parenthood, I might be able to get by without spending gobs of money, and without having to deal with any more bs-talking health insurance agents and collection agencies!

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I Can't Get Affordable Health Insurance

Do I really need healthcare?

Well, apparently I was denied coverage from PacifiCare due to my pre-existing conditions. That’s not good, since my health insurance agent basically told me that they’re the most lenient when it comes to this stuff, and I didn’t even note on my application that I have “major depression.” I just put down that I have anxiety/depression and took Lexapro and Xanax for this problem for one month each. To be honest, I’m done with meds for anxiety forever. I don’t like them, they don’t help, they make me feel sick, and they cost too much, even with insurance. I also noted that I have irregular periods, but I didn’t label it as “PCOS” because I thought that might get me denied. Oh, and I mentioned that I did have a ruptured cyst on my ovary last year. Yea, so I was pretty honest, minus fibbing a bit on my mental health diagnosis.

Anyway, fuck, I wasn’t approved. Now what? Well, my options, according to my agent, are signing up for a state plan where I’d be pre-approved but it would cost more. $240 a month for Kaiser, or $290 for Blue Cross. I’m pretty sure these are high deductable plans too. Yea right. I don’t make enough for those plans.

In short, it looks like I’m going to have to go without health insurance for the next ten years. I think that’s when I can wipe my mental health problems off my record. Let’s hope I don’t get into any near-fatal accidents between now and then.

Gosh this makes me sad.

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