Three expensive words

[Gratch]

So the bills have started trickling in for my recent dental nightmare.  At one point, I had to visit my doctor's office once a day for 4 consecutive days to get antibiotic IV treatments for my jaw infection.  Got a bill from the doctor's office for $1,600 for these 4 treatments yesterday afternoon, which was a surprise considering all the nurses there told me it would fall under my medical insurance.  Turns out, because the doctor wrote "jaw infection from oral surgery" on the initial diagnosis, the insurance company can claim it falls under dental and reject the charges.  If he had simply written "jaw infection", it would have been covered and I pay the discounted rate of around $400 total.  The rep I talked to was surprised he wrote from oral surgery as "they're usually pretty good about helping out patients with this sort of thing".  Gee, thanks doc...those three words just cost me $1,200.

On a side note, $400 per visit for a nurse to stick a needle in my arm and tell me to sit still for 20 minutes?  Hospitals and insurance companies can all go straight to hell.

[Huw the Poo]

Holy shit!  How can they possibly justify those charges?  It's times like these that I feel particularly grateful for the NHS.  I feel for you, Gratch.

[dbt1949]

I thought they were "I am sorry" to one's wife.
In other news they modified the damage to my wife's teeth to something over $17,000. Cash out of my pocket.
I feel your pain.

[Tebunker]

Call the doctor's office and argue, I bet you can get it reduced based on this. He cost you money, and enough huffing and puffing will generally work.

[Gratch]

I thought they were "I am sorry" to one's wife.
In other news they modified the damage to my wife's teeth to something over $17,000. Cash out of my pocket.
I feel your pain.

Yikes...I thought my $9k out of pocket was bad.  Sorry DBT.

[CeeKay]

wow, that sucks.  you'd figure an infection would be a health issue, no matter what the cause.

[Chaz]

wow, that sucks.  you'd figure an infection would be a health issue, no matter what the cause.

You seem to be unfamiliar with the American health insurance culture.  Just because something affects your health in no way means that it is covered by your health insurance.  The insurance company's job is to figure out how to pay as little as possible.

[Gratch]

wow, that sucks.  you'd figure an infection would be a health issue, no matter what the cause.

You seem to be unfamiliar with the American health insurance culture.  Just because something affects your health in no way means that it is covered by your health insurance.  The insurance company's job is to figure out how to pay as little as possible.

Yep.  If there is even the smallest possible reason for them to deny the claim, they'll throw it out. 

[Isgrimnur]

Co you not have dental insurance that the claim could be submitted under? (While I have read the other thread, it has been a while.)

[Gratch]

Co you not have dental insurance that the claim could be submitted under? (While I have read the other thread, it has been a while.)

My dental insurance sucks, and will only cover a maximum of $1,500 for the year.  I blew through that in my first two appointments.

[Isgrimnur]

Even so, can they still not apply their negotiated rates and then pass them on to you?  I know in our insurance briefings this year that that was mentioned for some of the alternate high-deductible plans.

[JohnathanStrange]

Dental Insurance is a source of frustration. My health insurance is very good and reasonable. My father has a similar plan that's worked out well for him - quick appts, good coverage, etc.

But our Dental Insurance is less reassuring. It covers basic exams, xrays, fillings and cleanings, etc. but anything much more? Not so much. I've not needed anythng beyond one filling 3 years ago but Dad had to have a tooth extracted and it cost him about $400 from a specialist who was able to see him the same day. A very professional man, the oral surgeon was, and a well-equipped office and staff eased my Dad's tension. He did think $400 for 10 minutes (actually seconds to pull the tooth) a bit much but people don't work for free.

My office colleague at Intel - an expat from England - had few good words for the NHS there: he told me that finding a NHS dentist who would take new adult patients and scheduling an appt. and actually getting the work done took him months. When I told him of my father's expense, he looked at me like I was crazy 'cause apparently he'd of paid double that to save him months of pain. We all pay one way or the other.

[Huw the Poo]

My office colleague at Intel - an expat from England - had few good words for the NHS there: he told me that finding a NHS dentist who would take new adult patients and scheduling an appt. and actually getting the work done took him months. When I told him of my father's expense, he looked at me like I was crazy 'cause apparently he'd of paid double that to save him months of pain. We all pay one way or the other.

Finding an NHS dentist is next to impossible in many places.  I don't have one - consequently I take damn good care of my teeth and so far haven't needed any work done since I was a kid.  But when you do manage to find one you'll pay very little for any work that needs to be done.  I check for one in my area every now and again.  "Take on new NHS patients?  HAHAHAHAHA!  Er, no."

[JohnathanStrange]

Health insurance and costs are hard to figure out – and dental insurance and costs seem the strangest of all. I took my grandfather to the doctor’s a few months back and he recommended an anti-shingles vaccination shot. His nurse said if she gave us the shot, it’d be something like $300 but if I went down the hall, I could have the pharmacist give him the vaccination for $40. Apparently, if it came out of “the doctor’s supply stock” they were required to bill us the higher amount. Such are the ways of accounting…

My grandfather’s dental bill for a tooth extraction (a tooth had broken) at another time, according to my father, might have been covered by his dental insurance except that, like the original poster’s account, the doctor had included something like having it extracted “by oral surgeon” which was explicitly not part of grandfather’s plan. Sigh…while it’s nothing like the huge charges others here have seen, just that recommendation meant we had to pay out of pocket. Ok, we did it, but I wonder what the real costs in health and dental care really are. Are we subsidizing all the low-cost maintenance by paying much more when something more major happens? Does it really cost more? Such are the ways of accounting…?

[Ironrod]

Are we subsidizing all the low-cost maintenance by paying much more when something more major happens? Does it really cost more? Such are the ways of accounting…?

Before fluoridation basic dentistry was lucrative. People starting developing fewer caries in the 1970s, which is about the same time that flossing started to catch on. Those two practices meant that baby boomers and subsequent generations needed fewer fillings, extractions, partial plates, and dentures. So you're right: since oral hygiene improved the money shifted to "catastrophic dentistry" and cosmetic dentistry.

Does it really cost more? I don't know, but I'd expect that the answer is Yes. A couple of generations ago you would've been heading toward dentures. Now it's about keeping your natural teeth alive, and that's bound to be more complicated.