He Who Wears the Crown

About a month ago I received a letter from my former dental care provider. I figured it would be a statement showing finalized payment for the crown that I had recently obtained – you know … a statement showing that my insurance had paid what they covered and, taking into account the five hundred bucks that I had already paid on the day of the procedure, that my account was now paid in full and clean. But it wasn’t.

What it actually ended up being was a bill. Not only that, but it was a bill demanding full payment – by me – for the remainder of the cost after my initial $500 was subtracted. It was stating that I owed them $475. It clearly stated that the amount covered by insurance was nothing and that no money was expected from my insurance as well. This got me to thinking…

I clearly remembered inquiring with the dental office on whether or not my insurance (United Health Care) would cover this procedure and remember their response. They said that 50% would be covered by my insurance and that I would be responsible for the remaining $500. This was back when I had the procedure done and, although I was a bit shocked to discover that a covered procedure would still be costing me $500, I wrote them a check for this amount. I then got the crown and proceeded on with my life thinking that this unexpectedly costly procedure was complete. A month ago, I got this bill clearly stating otherwise.

For completeness on this story, this actually was not the first correspondence with regards to this same procedure – the crown. For some reason that I still don’t understand, just a few weeks after the crown had been obtained; UHC sent me a letter requesting more information on the necessity of said procedure. It was the standard documentation about what they considered “fair and usual” charges versus what my health professional was charging complete with extremely unclear explanations – written in authentic legalese – for anything they decided they wouldn’t be paying for. The crown was one such item. For some reason they sent “me” the document requesting further proof of need for said crown – they wanted further documentation and X-rays.

Since I had neither any further documentation nor X-rays to send them, I decided to give my dentist’s office a call and see if they might be of some assistance. Hell, they were the ones that filed the insurance claim. Turned out that this was “news to them” and they requested I FAX over the document. This I did.

A couple weeks go by and I get another document from UHC – same thing as before with a request for some new information that I most definitely did not have access to. This one I decided to ignore. The way I figured it was that it really wasn’t my responsibility to get payment to my dentist from my dental insurance company. The dental office filed the claim and they can jump through the required hoops to get UHC to pay. After all, they’re the ones trying to get paid for services rendered. I already gave them my $500…

As I pointed out at the beginning of this article, I was mistaken. I called my dentist’s office (my former dentist’s office that is…) in an effort to discover why they believed I owed them another $475 and was basically informed that no payment had been received from UHC; and that therefore I was responsible for the outstanding balance. I then informed the nice lady I was speaking with that I disagreed. I explained how I distinctly remembered inquiring about the coverage of this crown prior to paying my initial $500. I also mentioned that I distinctly remembered being told that it would be covered. It was then when I informed this kind woman, if they were mistaken in their affirmation of insurance coverage, that it really wasn’t my problem. I basically wished them good luck at getting UHC to pay and informed her that no more money would be coming directly from me for this crown. She then suggested that I contact UHC and attempt to convince them to make this payment.

Maybe this is just a “pet peeve” of mine, but wasting my time and energy to basically go after an insurance company for not providing the services they are selling seems silly. I covered my ass by inquiring with the dental office about coverage prior to receiving service. I would have asked for it in writing but that seemed a bit excessive at the time. The verbal acknowledgement was enough for me. After that, the problem belonged to my dentist. Or so I thought…

You see that’s just the way health care is in this country (the USA if you were wondering). A large number of people can’t even get health insurance which – due to the outrageous prices for any medical procedure – means that they can’t get any health care. That’s just the way this game’s played these days. For those that are fortunate enough to have health insurance, the game changes a bit; however it’s still a game. Sure, you can get the health procedures done but, if your health insurance company decides you didn’t need it; you are going to be forced to pay the bill yourself. And don’t kid yourself into believing that your health insurance company cares – in any way whatsoever – about your well being; they’re only in this game for the money.

But I digress … I didn’t come here to point out the lamentable state of health care in this country. Michael Moore did an excellent job of that in his “Sicko” film. I came here to explain to you, the reader, why my former dentist has decided that he will no longer stoop to providing dental care for me. That was the letter I received last week. It appears that the nice discussion I had with the kind lady at my dentist’s office about being asked to pay for what UHC was not paying was enough for my dentist to drop me as a patient. So I guess the bottom line in all this is that I’m the “bad guy”…

Funny thing is that I logged-in to the UHC website shortly after my call to the dentist’s office and discovered that the payment had already been sent. I guess it had not reached the office prior to their demanding of payment from me; however it was on its way. I was even nice enough to call them back and let them know this; spoke with the same lady whose feathers I had apparently ruffled earlier. I thought they would be glad to hear this – they were getting their money after all. Heck, UHC was paying the full $500 which meant that I was only responsible for $475 of the $500 I had paid earlier – they were ahead by $25!

The denial of service letter that I received also contained a check for $25. So, financially at least, we (my former dentist and I) are now even. I need to locate a new dentist for any future dental work, but at least the financial audit trail is clean. I’m just a bit confused as to how I’m being labeled as the “bad guy” in this situation. Perhaps I should send my ex-dentist a bill for $475 and see how he likes it…

bis später,

Coriolis