Maybe I Should Switch Jobs…

…And become a crusader for fair and honest dealings between dentist, patient and insurance company.

After our recent experience, we’ve been searching for a new primary care dentist. Problem is none of them are paying any attention to the insurance company’s policies.

First there are the offices that offer the “covered” filling type, but only in certain cases. In these offices, we’re stuck paying the difference out of pocket. Never mind the fact that for the procedure we have to have done, they won’t use the “covered” filling (doesn’t that mean it’s not offered?). Since the office uses the “covered” type of filling sometimes, we have to pay for getting the “upgrade” filling. Our insurance company agrees that while this is not honest or fair, there’s little they can do in this case. Doesn’t make too much sense to me, but moving on.

Then there’s the office that doesn’t offer the “covered” filling type. Great, right? “They can’t charge you the difference if they don’t offer the “covered” type of filling,” so says our insurance company (and I’ve verified this information with them on three separate occasions). But a call one such office proved less than stress free.

Me: Do you offer “covered” fillings, under no circumstances?

Receptionist: No. The dentist feels they’re unsafe

Me: (in my head) Fair enough. Should make things easier. (aloud) So I assume that means that the patient is not responsible for paying the difference in cost.

Receptionist: Let me transfer you to Insurance Specialist.

Me: Thank you…

Specialist: …We still require patients to pay the difference.

Me: My insurance company says I should not pay any out of pocket in this instance. Do you charge the patient only if the insurance won’t pay?

Specialist: The patient must pay up front – no exceptions.

Me: Even though you don’t offer “covered” fillings I still have to pay the difference up front, before you even contact my insurance company to see if they’ll pay?

Specialist: Yes.

Me: You must have to make a lot of refunds.

Specialist: We’ve never done a refund.

Me: Thank you.

These are the only types of offices I’ve found. I’m getting a little frustrated.

On a positive note, when I contacted the insurance company about the second type of office, they agreed that their practice was a breech of provider contract. Getting paid twice for the “upgrade” fillings – once from the patient up front, then again when the insurance company is billed – is apparently a no-no. Go figure! Because of my call, the insurance company is filling a complaint against this office. Hopefully it all works since this has been the only office I’ve found that accepts toddlers.

Maybe I won’t give up my day job for a life of fighting injustice just yet. Then again, super heroes usually keep their day jobs, don’t they? I suppose its better that way. How could I leave such cute faces?