« Positional Inequality Among the Young and Carefree | Main | I Play Ball, Hard »
July 12, 2007
Delta Dental's Terrible Coverage
Delta Dental is currently arguing that my root canal -- done at an in-network dentist -- does not merit much in the way of reimbursement, and is telling me that my share of the procedure comes out to around $2,000. A procedure, mind you, that's already been done, and that appeared to be fully covered. A procedure, too, that was by all accounts medically necessary. This is what you get when your insurer makes its money by not paying for your claims. I'm pretty sure that this will eventually be covered, but not without a lot of hassle and argument, all of which is designed to convince me that it's not worth the trouble and I should just fork over the cash, which would then count as pure profit for them.
This is how they earn money, people. This is how it works.
July 12, 2007 | Permalink
Comments
How do you know it was "medically necessary"?
How do you know that your dentist was simply not trying to make as much money as possible by doing any invasive procedure he could on you?
Posted by: joe blow | Jul 12, 2007 12:34:39 PM
You're obviously on some medical-industrial complex retaliation black-list!! They will stop at nothing!
Posted by: otto | Jul 12, 2007 12:35:37 PM
joe blow, how do we know that Ezra didn't make a secret agreement with his dentist and the Lizard people underneath the Denver airport to lie about tooth pain so they could all get some free money from Delta Dental?
Posted by: Joshua | Jul 12, 2007 12:43:43 PM
joe blow, that's not Ezra's problem. That's an issue between Delta Dental and their in-network dentist. If there's a problem of fraud, then Delta can drop the dentist from their network and sue the dentist for breach of contract.
If Delta thought it was worth their time. A cost/benefit analysis would probably say that they're better off trying to convince Ezra to write a check for something that Delta should have paid for in the first place.
Posted by: Tyro | Jul 12, 2007 12:46:12 PM
Yes!
So remind me again why Physicians for National Health Porgram, and others who support single payer, and make the point that the insurance companies are the problem and that any of the various mandate programs even Edwards that leaves them in place... remind me again why that is not the best solution to work for...?
I know you are sorta supportive, but like Jon Cohn, why the reticence to come out for real single payer that gets the insurance companies out as unecessary middle men. Why so good at diagnosis, but waffling about the cure?
Posted by: DrSteveB | Jul 12, 2007 12:46:40 PM
If you had that wonderful health insurance called Medicare, you would find that it does not cover dental services except under very limited circumstances related to the treatment of other serious conditions. For a more complete discussion, look here
Posted by: BC | Jul 12, 2007 12:48:31 PM
Another excellent point SteveB-- doctors, by and large, hate insurance companies. They hate the health insurance companies, they hate the HMOs, and they hate the malpractice insurers. Who likes the insurers? Congress, because the insurers keep their campaign warchests full.
Posted by: Tyro | Jul 12, 2007 12:49:48 PM
Delta Dental is very close to a sham/fraud. But, it is nearly the only (dental insurance) game in town.
Somehow, the US citizen has been convinced that dental problems are not medical problems - in spite of clear evidence that teeth/gum problems can, literally, end your life prematurely. The same can be said about mental health issues.
Fixing this huge gap between the oral care that the people need and what is affordable will be very expensive since so many have done without dental care, even when well insured for other medical problems, that becoming insured (adequately) would expose the insurers to literally generations of neglected care to be brought to an (expensive, because neglected) end.
I have nothing good in general to say about health savings accounts (HSAs), but a wise person might well consider it just to handle dental or mental problems that might arise, since employer-provided health insurance is essentially never going to cover this area adequately - witness Delta Dental.
Posted by: JimPortlandOR | Jul 12, 2007 12:52:39 PM
Delta Dental is very close to a sham/fraud. But, it is nearly the only (dental insurance) game in town.
Somehow, the US citizen has been convinced that dental problems are not medical problems - in spite of clear evidence that teeth/gum problems can, literally, end your life prematurely. The same can be said about mental health issues.
Fixing this huge gap between the oral care that the people need and what is affordable will be very expensive since so many have done without dental care, even when well insured for other medical problems, that becoming insured (adequately) would expose the insurers to literally generations of neglected care to be brought to an (expensive, because neglected) end.
I have nothing good in general to say about health savings accounts (HSAs), but a wise person might well consider it just to handle dental or mental problems that might arise, since employer-provided health insurance is essentially never going to cover this area adequately - witness Delta Dental.
Posted by: JimPortlandOR | Jul 12, 2007 12:52:46 PM
Two personal opinions from a non-lawyer: Use US Mail, Certified (or Registered for key letters) and printed pages only. No e-mail or phone calls.
And after the second round, start using the phrase "could be construed as flagrant failure to [...]".
Cranky
Posted by: Cranky Observer | Jul 12, 2007 1:06:34 PM
Yes, this is how it works. I think everybody has a story like this. Two of mine:
1. When my twins were born, the insurance company denied ALL charges related to the birth of the second child, reasoning that her birth was "incidental" to the first birth. The doctor ended up just eating this.
2. When those twins needed (very expensive) RSV shots (to immunize them against RSV), the friendly insurancy lady on the phone explained that RSV shots did not fall under the (generous) "immunization" coverage, because immunizations are limited to shots given to prevent future diseases, not to treat existing illnesses. [pause, pause]. "But my children do not have RSV. These shots are to prevent that." [pause, pause]. "Let me get my supervisor."
Again, the bottom line is: the business model is to deny, deny, deny, and let the little guy try to fight for what they can get.
Posted by: JWR | Jul 12, 2007 1:10:13 PM
I've experienced the exact same thing repeatedly as a provider. The companies delay payments as long as they possibly can, knowing that the providers will give up on some of the smaller ones, and they can then keep the money. Providers have to either spend a lot of their time fighting to get paid, or hire armies of administrative staff (at their own expense) to do it for them. This nonsense drove me out of private practice; I now work for the state and a private nonprofit community mental health center.
Posted by: beckya57 | Jul 12, 2007 1:15:28 PM
My experience with Delta Dental was bad enough that I'm seriously not sure I can relate it without running afoul of libel laws. This year, my employer switched to another outfit (don't remember the name off the top of my head), which seems to be better.
Posted by: JWP | Jul 12, 2007 1:22:02 PM
If you had that wonderful health insurance called Medicare, you would find that it does not cover dental services except under very limited circumstances related to the treatment of other serious conditions.
Yes, this argument makes perfect sense. Because Medicare, LIKE ALMOST EVERY OTHER MEDICAL INSURANCE PROGRAM, doesn't cover dental care, we can deduce that any attempt to extend Medicare is fatally flawed.
Better class of insurance company shill, please.
Posted by: paperwight | Jul 12, 2007 1:22:25 PM
There are many different Delta Dentals. They were the dental association answer to BC/BS. Some are incredibly rich, but, as not-for-profits, cannot do much with their money. They have no reason to collect as much as they do or be unreasonable in their coverage.
Posted by: freelunch | Jul 12, 2007 1:25:21 PM
Oh, great. My insurance just got switched to Delta Dental. They're handling checkups ok, but I've got some serious work that needs to be done over the next few years, and I was hoping to not have to pay for it all myself.
Of course, all dental insurance pretty much sucks.
Posted by: Stephen | Jul 12, 2007 1:25:23 PM
How do you know that your dentist was simply not trying to make as much money as possible by doing any invasive procedure he could on you?
In which sentence joe blow unwittingly makes the information asymmetry argument against consumer driven healthcare. Of course, blow and fellow travelers would then argue that "if you paid fer it yerself, you would look a lot closer at the treatment." Ah, yes we would.. based on what diagnosis, exactly? One's own? Or some evil used-root-canal sales-dentist trying to wring cash out of you?
Again, better class of shill, please.
Posted by: paperwight | Jul 12, 2007 1:25:32 PM
I have to disagree about the usefulness of HSA's. I have one through my employer, which has a policy of rejecting every claim of an amount different from my insurance co-pay. If I use the account for what I intended, things like glasses and dental work, I have to file a claim in exactly the same way as I would an insurance company. If I fail to provide enough information, the account is locked so that I can't spend it, but the money is still automatically deducted from my paycheck each month. Nice work if you can get it.
Posted by: Karen | Jul 12, 2007 1:29:28 PM
Jim is right-- dental insurance, across the board, sucks ass. There is nothing covered that appears covered, and if it is actually covered, they will find some way to say your $1000 procedure should have cost $50, and then apply the $50 to your deductible. It makes even shitty health coverage look like universal healthcare by comparison.
Posted by: Jeff in Texas | Jul 12, 2007 1:33:21 PM
Which is why one component of "Sam's plan for better cheaper healthcare" is a claims clearinghouse, that works like the Fed's check clearinghouse.
Standard form to file for re-imbursement
Standard place to file the form
Standard coverage levels
Prompt payment
Posted by: SamChevre | Jul 12, 2007 1:40:03 PM
I suppose car companies make their money by building broken cars, computer companies make their money by building dysfunctional computers, etc. Oh wait, if they did that, they would go out of business.
Posted by: Jason | Jul 12, 2007 1:40:19 PM
Dental insurance makes no sense. Think about it; there's no healthy group to subsidize the cost of the unhealthy ones. Even people with good teeth need checkups, cleanings, the occasional filling or crown or root canal.
Until they can convince the insured that those procedures are optional, they'll never make any money.
Posted by: KathyF | Jul 12, 2007 1:43:57 PM
Oh. I thought Joe Blow's comment was a joke.
I thought that at SiCKO screenings, Michael Moore should have asked the members of the audience to raise their hands if they had a horror story about insurance and medical treatment. I suspect that the vast majority of the audience would raise their hands, and that would be a useful thing for us all to see.
Posted by: Megan | Jul 12, 2007 1:44:44 PM
As I recently told a candidate campaigning for US Senate, one should not buy into the conventional wisdom that doctors would fight single payer tooth and nail. Some of them would, but many others of us recognize the current system is a mess and a national disgrace. Doctors, by and large, are intelligent and caring people, and seeing the limitations of the status quo, many of us are ready for single payor.
Medicare is not perfect either, but at least Medicare doesn't spend 15-30% of their money on lower administrative staff whose job is to refuse coverage whenever possible, or on higher administrative staff who literally make millions when that lower administrative staff is successful.
Posted by: pdq | Jul 12, 2007 1:48:48 PM
Ezra Klein,
If you are going to claim you are being ripped off, then I think it necessary for you to provide more details than what you have so far. How about a cite of the section of your policy that covers root canals, for example?
Posted by: Yancey Ward | Jul 12, 2007 1:49:18 PM
The comments to this entry are closed.
