no fillings for you! (but babies are OK; please make us some babies!)
I had gotten around insurance not covering my birth control pills by simply having my doctor write a letter to the pharmacy and insurance company stating I needed them for "medical reasons"--such as cramps, i.e. A few weeks ago I received a letter stating that any form of birth control would no longer be covered by insurance, unless a doctor stated they were being taken for infertility reasons, or if you were never intending to / going to try becoming pregnant. Well, I don't fall into either of those categories. So now, I'll be back to paying $35 for my prescription, instead of the $8 - $10 a month I WAS paying. Guess that's what I get for switching to an insurance provided throught the Archdiocese, huh?
AND, to top it off, I now have a $630 balance for my dentist that I will have to somehow pay...out of my own pocket. I went to have some work done on my teeth, and the receptionist broke the news to me: "We don't accept this insurance...this is an HMO that we're not affiliated with...You have an outstanding balance of $630 that the insurance company has not / will not pay on..." Needless to say, I left without having my fillings done.
So, not only do I have to pay $630 out of my pocket, but I also have to find a new dentist. What I don't understand is: how did the dentist NOT KNOW my insurance would not cover my visits...after I've already been there 3 damn times? I was told, BEFORE I scheduled my FIRST appointment with this particular dentist, that insurance would cover at least part of it. Mind you, I was told this by both the dentist's office AND the insurance company. Now, all of the sudden, after they've wracked up close to $1,000 in work, my insurance WON'T pay? I don't get it. But, when I got home, I looked in the provider directory, and sure as shit, Dr. Stolle was not in there. Maybe I should have done that in the first place, but I guess I figured that when I CALLED THE INSURANCE COMPANY and specifically asked if my dentist / dental group would be covered and they told me yes, they were telling the truth. Obviously not.
This insurance shit sucks.
posted by ~stacey~ @ 6:47 PM
3 comments
3 Comments:
Total suckage. For the most part, I hate medical/dental insurance companies. They're always looking for a loophole to get out of paying for services, sticking it to the consumer. Which makes no sense. That's why we have insurance in the first place!
I don't know if it will get you anywhere, but you might want to try calling the insurance company and asking to speak with a supervisor. Especially since the insurance company itself told you that the services would be covered (using your dentist, I presume). I have come to understand that the companies will often deny a claim in the beginning because most people won't try to fight it, but if you make enough noise, appeal the decision, etc., sometimes they will eventually pay it.
Of course, I can't offer much hope on that myself, as BC/BS STILL hasn't paid for my oral surgery from last Spring. :( But I figure it might at least be worth a phone call.
Good luck (and much commiserating).
Yea, I'm not too fond of / impressed with insurance companies right about now. Thanks for the advice, Joan.
So sorry to hear about your grievances against your HMO (you're certainly no the first one). I've just recently learned that in both HMO and PPO's, providers can be within network one day, but out the next, so your best bet is to call the HMO on the "day" of your appointment and not when you make the appointment. Also, you can appeal your invoice within 30-60 days, so call the HMO and speak directly to the claim's supervisor. And good luck!
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