Monday, July 12, 2010

Who Pays The Piper?

I spent the morning haggling with the insurance company over payment on the free teeth-cleaning that we get every year. Yeah. Farmer H has dental insurance on all of us, which is not a great deal, but has $1000 of benefits per person, plus a free cleaning. Being a sensible person, I schedule both boys on the same day, at the same time.

Insurance paid $145 on The Pony's chompers, but only $95 for #1. They both had the exact same exam, with 2 bitewing x-rays, fluoride, and the cleaning. The services were billed in an identical manner. What's up with that? Surely they don't think The Pony is more cuddly and deserving of free teeth cleaning. I called the customer service number of Guardian, which is the company in charge of the dental insurance, and navigated my way through their automated format. Pity I no habla Espanol, or I would have saved myself five minutes before getting a live person.

First, I was told that the bitewings were not covered, because it hasn't been 12 months since the last x-rays. After pointing out that The Pony's were covered at 100%, and both boys have had identical appointment dates and exams, the rep changed her story. Seems that #1 is not a child, since he is over 12 years of age, yet his service was submitted as a child's fluoride treatment. And since he's not a child, it's not covered. However, it seems as if he's a partial child, because while The Pony's fluoride was paid at the full $27 rate, #1's was paid at $10, which doesn't sound to me like that child thing is gonna fly. An additional fly in this fluoride ointment is the fact that Farmer H's cleanings are always paid at 100%, so is there such a thing as an adult fluoride treatment, and if so, would #1's be paid if submitted as an adult treatment? The rep said yes. Or maybe she was just humoring me, in case the call was being monitored. Probably at a cost of $17.

The rep said she was researching it, and came to the conclusion that a child is a child until the age of 19, and she needs to do some further research to figure out where that missing $17 of fluoride payment went.

Shame on me. I have a mental image of one of those Mexican children who wait at the Arizona border every morning to ride the school bus to the Arizona public schools getting a fluoride treatment for free. Shame on me. I don't pay Arizona taxes. Bring everybody across! A round of fluoride for all of our friends from south of the border!


Kathy's Klothesline said...

My theory is that the insurance companies do this sort of thing routinely. Since it was only $17, most people won't bother to ask and some people don't even look at the bill, just pay it blindly, then there are those who would have been satisfied with her first oe even second answer. It is only $17, but if 1000 people over pay the bill by $17 ........ well, you are a smart woman and can see where I am going with this.

Hillbilly Mom said...

One time, my checking account was off by $32. I investigated, and found that one of my checks had been subtracted twice. The bank did an audit of my account, and found out it was an inside job. But they wouldn't tell me at what level someone had helped themselves to my $32. I would have liked to know if it was my local branch, or someone higher up.

Imagine how many accounts they could have double-dipped a check from. It's the premise, not the $17.