I cannot call it a horror because it was only an expensive, painful and annoying example of insurance company double gotcha but no one died or was disabled.
You see I am one of the "lucky" ones with a full time job and health insurance (but we cannot afford the family policy)but year after year of double digit increase in premiums and finding the copay and deductibles made everything but the most expensive care now out of pocket. This is a story of a public employee with the "best" insurance in the area. God help the rest of you......rest after the fold
I have both medical and dental insurance. Many people would love to have that right but somehow I came across a situation where neither worked - so I figured that having insurance meant only I had the PRIVILEGE to pay health premiums not necessarily use it or get health care.
It was December 19, 2006: I broke a tooth. I called my dentist. There are few dentists here and any dental care takes a year to get. His compassionate response was - our office is going on holiday - call us when we get back and we will see if we can fit you in. When are you coming back? January 12th.
However by Saturday December 23rd I had a roaring toothache. I called every dentist in town - but being a holiday and a weekend - no one would see me. The best I could do was call the dentist's backup dentist and try to get in - when - if I could get an appointment - January 8th.
After seeing me suffer for 12 hours my husband said - we have to find a doctor. So he calls urgent care (closed) and finally decides to take me to the local regional (for profit) hospital.
To their credit they weren't busy and took me quickly. They could not do anything about my tooth. They didn't even look at it. Basically they gave me a pain killer and an antibiotic and advice to see a dentist. 15 minutes - oh and they took my blood pressure
$500 please (cha-ching)
I submitted it to my medical insurance - denied - reason it was dental care - not covered. My reasoning that it didn't matter whether it was dental or not because they didn't treat the tooth they treated the pain fell on deaf ears.
I submitted it to my dental insurance - denied - service wasn't performed by a dentist. Even though the policy covers palliative care.
Both me and the HR department of my employer has exhausted appeals and as a result the HR department fired the dental provider but there is no evidence the new one is better.
My husband figures with holidays, weekends, long vacations and the fact he only works 3 1/2 days a week anyway I pay for full time dental insurance but if any care has to be provided by a dentist then the insurance company make twice as much since they don't have to provide coverage anytime he is not working. There are no dental clinics here. Urgent care is only open limited hours and don't have dentist either.
I haven't seen a lot written the crack between dental and medical and I am sure there is a crack between vision and medical. Big yawning one.
As bad as all this is I do have some coverage I guess but anytime I use it I get the coverage denied for one reason or another. But I do have something - more than my husband does. His employers policy to cover him is over $550 a month - just him. I hear it is good insurance but that is 15% of his total salary - he cannot afford it.
Many people here cannot afford the health insurance - we are self insured and the brunt of the increases have been in the family coverage - which is ironic - we work with children but most of the employees with children cannot afford the family coverage. It puts the crushing increases on the backs of the youngest employees and those families with kids.
I am not sure if the public option would include dental or vision. I never understood why they were treated like they weren't attached to your body and had separate policies.
Still we need the public option to protect us from this insurance policy of being allowed to pay premiums but there is any excuse to deny paying for any actual care.