Insurance Scam? Dental Insurance Q inside

[Hoax]

I read all four of f13's widom teeth threads.

http://forums.f13.net/index.php?topic=16409.0
http://forums.f13.net/index.php?topic=8760.0
http://forums.f13.net/index.php?topic=10246.0

Those are gems. You should read them, especially if you are Nerf, Marg or Yeg.

That said I was hoping to find info about payment. I need to get my teeth pulled, to make matters worse I have five of them, which is fucking annoying. I don't have dental coverage for oral surgery. So I find out its going to cost thousands of dollars I don't have. This is where it gets interesting.

I call up Blue Cross (my insurance) and talk to sales about if they can hook me up with some no contract length kicks in instantly dental coverage that will make elective surgery cheaper. Yeah right as if that can happen. Sales tells me if I go HMO they will charge me $16.50 a month, no contract length no wait time and I will pay $200 or less (depends on type, bony, soft, partial etc) per tooth for extraction. No coverage for the gas but still fucking sweet since without any coverage it will cost $400-600 depending on the surgeon.

So what is the catch I'm not seeing? I flat out asked sales how can they stop people from jumping in getting the procedure and jumping out of the risk pool and they said they can't and don't worry about it for dental unlike health. I still don't trust insurance for I'm asking if anyone else knows anything.

[Hoax]

lulz

I figured out the scam. Fucking HMO's I was expecting limited options but it turns out there is one fucking surgeon in the entirety of san francisco they will let me use. Yeah I wonder how long that wait list is. They also make you sign up w/ a primary dentist first which could mean who the fuck knows what exactly. Probably that I would need to see him/her first to prove I have wisdom teeth that need pulling.

[Sky]

Yep, you got it. We are on the city's insurance even though we're independent, a couple years ago they went HMO, a few of us stuck with the PPO, the move had to be voluntary. They weren't providing the answers we wanted to hear, but most people were all 'cheap prescrip rider!!!1 WHAR DO I SIGN!?'

[Yegolev]

Those were Classic Threads indeed.

I miss schild.

[Ingmar]

Coverage does kind of vary - my HMO option is cheaper than the PPO option I have and my dentist will take either, so the HMO is a no-brainer really.

[Lantyssa]

It may not apply to this policy, but our best plan took three years to ramp up to full coverage.  You might want to check for that, too.

[ghost]

The catch is that you have to be very, very, very careful which clinician you let do the work.  Some dentists are not so good, and a lot of ose types are on HMO plans.

[Nerf]

1 surgeon, in your city? Lucky fucking bastard.  My insurance was the same bit - $16 a month or so, except I had it long before I needed the wisdom teeth out, and that there wasn't a single provider in the entire Dallas/Fort worth metroplex that would actually *do* a surgical extraction on my insurance.  I figured hmm, maybe a fluke, so I had them expand the search radius to 100 miles and found nothing.  After several attempts of searching different cities with different radii, I just had them search the entire state of Texas.  Not one fucking provider that would actually do it.  I'm not sure why they even bother putting a price and saying "we cover this!" if they don't actually have any providers that are willing to do it.  Cocksuckers

[squirrel]

Fuck am I glad I'm Canadian.

[Hoax]

It may not apply to this policy, but our best plan took three years to ramp up to full coverage.  You might want to check for that, too.

PPO's always have a ramp up from my experience but the HMO plan did not I triple checked that fact. That was why I was searching for a catch, its just shocking that insurance would even exist that you can't really use because nobody is "in-network".

I call the sales guy and the second I start talking about it he knows the deal is off and his whole attitude changes, god bless this great land and our marvelous HMO's.

[ghost]

In all honesty-  if there is a dental school with an oral surgery residency I would check there and see how much that would cost.  If you need five teeth out it could be a long day with someone that has no idea what their doing, and the residents are generally quite skilled.  You could even get away with a dental student, in a lot of instances, but again, it can be dicey when it comes to talent level.


Edit:  And really dental insurance as a whole is a complete scam.  Typically even the good ones won't cover enough to make up for years of paying the premiums.  The only time it is good is if someone else is paying for it, and if you get that "lucky", typically you run into the same situation Nerf experienced or you end up with a dentist that shouldn't even be performing dentistry on corpses.

[sinij]

I am Canadian working for The Government in US. I still maintain residence in Canada so I don't have to deal with shit like above, despite the fact that benefits at my current place considered Cadillac by natives. Medical bills (100% covered by insurance for me) boggle my mind, trivial visit to doc with some bloodwork done dinged for over $2,000. Imagine if I was diabetic cancer survivor with couple other complications...

[Lianka]

I am Canadian working for The Government in US. I still maintain residence in Canada so I don't have to deal with shit like above..

Is it real residence, or residence in name only?  Do you have to spend some time there, pay taxes, etc, to retain your provincial health card?   

[Morat20]

I am Canadian working for The Government in US. I still maintain residence in Canada so I don't have to deal with shit like above, despite the fact that benefits at my current place considered Cadillac by natives. Medical bills (100% covered by insurance for me) boggle my mind, trivial visit to doc with some bloodwork done dinged for over $2,000. Imagine if I was diabetic cancer survivor with couple other complications...

I'm having minor surgery done next week. It's an endoscopic procedure (requires a general anesthetic. Twilight's not enough, because they're releasing a tendon and the surgeon is under the impression that a foot twitch at the wrong second might lead to a lot more than a 'release', like more of a "you know that tendon on the bottom of your foot that attaches to your heel? It doesn't anymore. Good luck moving that") takes 15 minutes of surgical time (+45 minutes for me to get knocked out).

I have gold-plated health care, for an American. I've shelled out...500 so far, with another 200 due at the surgical center, and I can promise you my next year will be filled with various invoices from the doctor, the surgeon, and my health insurance company all claiming I owe different amounts with absolutely NO WAY to tell who is right.

[Lantyssa]

My hospital bill for the abscess was $36,000.  "Insurance Adjustments" knocked $25,000 off at least...

That's only the hospital, not any of the doctors.

[Morat20]

My hospital bill for the abscess was $36,000.  "Insurance Adjustments" knocked $25,000 off at least...

That's only the hospital, not any of the doctors.

And you can't tell what is and isn't covered. "Oh, we cover 100% of all standard labs, and 80% of all 'reasonable labs' and 40% of any other doctor ordered labs" and when you ask "What's standard, what's 'reasonable' and what's not" they say "Look at the information your company gave you" which...just repeats the blurbs about 'standard', 'reasonable' and 'not' and self-defines them.

I can't ever tell what is and isn't covered, if I'm being double-billed, or being charged too much. It's a confusing mess -- and then you add in that, where the doctors first charge you what they'd charge cash patients, then knock it down to what they charge your insurance company, bill you some percentage that should be what you owe but MIGHT be them trying to -- illegally and against the contract with your provider -- the difference between what the insurance company negotiated with them and what they'd like to charge.

It's fucking unreadable. How about we just have universal health care, and a standard deductable for office visits and medications? PLEASE? I'll happily pay more for some sanity.

[sinij]

I am Canadian working for The Government in US. I still maintain residence in Canada so I don't have to deal with shit like above..

Is it real residence, or residence in name only?  Do you have to spend some time there, pay taxes, etc, to retain your provincial health card?  

Nobody questions it as long as I pay my taxes. I spend maybe a week per year in Canada.\

As to my medical emergency fund - I have enough money set aside for a first-class direct flight to Canada.

[apocrypha]

How about we just have universal health care, and a standard deductable for office visits and medications? PLEASE? I'll happily pay more for some sanity.

Because that's SOCIALISM!! What are you, some kind of terrorist!?

Besides, sounds like you all pay way more than enough already. Way fucking more. And god help us in the UK, we're heading the same way now. Slowly, and by the back door, sure, but our universal, free healthcare is under serious attack and the American system is the model that they seem to be aiming for.

 

[Merusk]

Yeah, I heard that on NPR earlier this week.  I considered posting "Hey, welcome to our world to all our friends in the UK." in the Healthcare thread but decided against it.

[Samwise]

the American system is the model that they seem to be aiming for.

[sinij]

The American System - best system in the world for 100% healthy and rich.