You'd have to be a hermit who has been living in a cave for the last 100 years to not realize that one of the biggest issues in the United States is healthcare. People have all kinds of pros and cons for wanting one solution or another; politicians running for office promise great solutions that will make everyone happy with either no intention of delivering on their promises or no plan for delivering on their promises, or both. Usually one reason people trot out for not wanting any kind of single payer or universal healthcare is that they don't want to deal with the inefficient and heartless government bureaucracy. Definitely, the private sector works like a well-oiled machine- and it's not confusing or complicated, and everyone knows exactly how much things are going to cost. I can't imagine why anyone would want something different.
So someone in the Family of No needs oral surgery to extract some wisdom teeth. The Mom of No has medical insurance and springs every pay period for the extra dental insurance because hey, four people, that's a lot of teeth- and the Mom of No had a root canal earlier this year, so the policy has already paid for itself, because those root canals are expensive (and painful). I should have done a better job of flossing in my youth; lesson learned. So the oral surgeon's office is called, appointments are made, and of course then it comes time for the healthcare acquisition ritual known as "We Must Discuss Your Insurance Benefits Before Care Can Commence".
"Well", the benefits coordinator tells me, "Medical is your primary insurance, so we have to file with them first, but they're a non-participating provider. Your dental insurance should pay it but we can't submit the claim to them until your medical insurance denies it. That will take several months, so in the meantime, you'll have to pay the balance and wait for the claim to be paid. She makes it sound like having two policies is a huge imposition. It's not my fault that's how my medical insurance is, I want to say.
Wait, what? That's not what the dental insurance benefits book says. I eyeball the clock, hoping that I'll have time to get some dragonfly hunting in before dinner. I sense that yes, this is about to get complicated.
The benefits coordinator is unimpressed with my knowledge of my dental plan benefits.
Doesn't matter, she says. That's our policy. Because you have two insurance plans. We're only doing this as a favor to you. Usually we just file one. But the secondary insurance you have is easy to work with. So lucky you. But you still have to pay up front.
But my medical insurance won't even pay anything, I tell her. It doesn't even cover dental procedures. That's what the other policy is for. That's not how they do it at our dentist's office. That's why I bought this policy. So that I wouldn't have to pay the entire cost of stuff like this.
It doesn't work that way, she says. That's how we do it. We don't care how they do it at your dentist's office.
So what do I have to pay? I ask her. It's impossible to say without filing the claim, she says. It depends on how things are coded. You might have to pay 30% of the extractions and 15% of the sedation. Or, maybe it's 50% of the sedation and 35% of the extractions. Plus, she mentions, there's another procedure that involves taking blood and putting it on the extraction site, and insurance doesn't cover that. It depends on what your medical insurance pays. Then there's your deductible. But that's after we file the claim. You have to pay the entire cost up front.
So, I'm paying the oral surgeon more money than I'm supposed to pay for a procedure and no one can say how much it will cost because no one knows what the insurance companies will pay, and then I wait to hopefully get some money back at some undefined time in the future after the dueling insurance companies duke it out at some point in time that is convenient to them. Absolutely makes sense.
So at this point I call the dental insurance company. The rep there tells me that contractually, they can't require me to pay the entire cost. With some technical assistance from The College Student, I manage to get the surgeon's office, the insurance rep, and me on a three way call. This turns out to be a bad idea; almost immediately the benefits coordinator and the insurance rep start screaming at each other. I look at the clock again. I've been on the phone for nearly an hour. I can't take it anymore. I'm absolutely baffled. I need nature. If this were an old fashioned phone on one of those spiral cords I would bang it against the wall, but I don't want to break my mobile device so I settle for rolling my eyes and beating the palm of my hand against my forehead.
Nothing gets resolved.
So today I spent an hour of my life (and I'm about to turn 50, so the clock, it's a-ticking - every moment spent arguing about insurance is an hour less to spend in nature) on the phone trying to work out how much a wisdom tooth extraction will cost me, and I'm still confused. Why do we do this to ourselves? We're a nation of smart, resourceful people. Maybe one day we'll work it out; maybe one day we'll get tired of jumping through hoops to get a few teeth extracted.
