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For basically my entire undergraduate career, I did not have health insurance. Because my mom was on Medicare, I obviously couldn't be covered under her plan, nor could I even be considered for Medicaid (some stupid rule about the same household not being allowed to have both Medicare and Medicaid). In other words, I rarely went to the doctor. I took advantage of a community clinic to get my prescription blood pressure medication (kind of important), but other than that, I almost never visited a physician. And I never went to the dentist. I knew I had some issues, but any kind of major procedure just wasn't an option.

Fast-forward to a few weeks ago. If you frequent Top Comments, you probably know more than you ever wanted to know about my mouth woes. No medical professional has thus far been able to fully explain the horrors that were going on in my mouth (including massive swelling, bleeding, and weird tongue issues), but the best guess is that it was mostly a periodontal issue related to my teeth needing a serious cleaning. And when I visited the periodontist, that's exactly what I got: a root planing, or a deep cleaning. Very unpleasant, as you can imagine, but necessary. And I haven't had issues since. Thankfully, now that I'm actually employed and have benefits, I had my awesome dental insurance to fall back on.

Oh, wait...NOT. Follow me below the fold for my tale of dental insurance woe.

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The root planing, without insurance, would have been several hundred dollars. But, fortunately, the periodontist's office checked, and it was a covered procedure under my insurance plan. I still had to pay $140 out of pocket, which hurt, but it wasn't going to break me. And it was a completely necessary procedure. So I shelled out the $140 and got my deep-cleaning.

Fast-forward to yesterday. I'm feeling much better, and I'm flossing a lot more so I won't have to go through that awful procedure ever again, and life was good. And then I went to my mailbox.

I found a letter from my insurance company. Okay, I thought, it must just be a summary of what they covered. I opened it up. Funny...under the "Paid Out" column, there was nothing. Under the "Amount You Owe" column, it said $452.

I must be reading it wrong, I thought. So I decided to give the insurance company a call and ask them to clarify. When I did, a lady very cheerfully told me that, yes, I was reading the statement correctly. My claim was denied, and I would indeed owe $452.

I asked why my claim was denied. After all, the periodontist's office checked on this before they performed the procedure. She told me it was because it didn't qualify. I asked why it didn't qualify. She said that the powers-that-be at the insurance company determined, based on the information the periodontist's office provided, that no root was exposed prior to the procedure. Therefore, I didn't need a root planing.

Nothing like being told by an insurance company representative what I "need" (yeah, I know, that's what they do all the time). I'm pretty sure the two weeks I spent in oral hell would like to have a word with this insurance company.

After going back and forth for a while, I asked to have the periodontist's office brought on the line. The person at the office was just as surprised as I was. She said it was very clear that my root planing would be covered, but the insurance company representative maintained, very (sickeningly) cheerfully, that my root was not exposed, and I therefore was not eligible to receive a root planing.

And that's pretty much where it ended. So now, the periodontist's office (which has been wonderful about this) is submitting a request for reconsideration on my behalf. After that, I have the right to appeal on my own. All of that should take several weeks. But I don't have high hopes for the outcome. For some reason, I don't see the insurance company caving on this. But we'll see. If not, I guess I'll have to add $452 onto my existing medical debt. I'm starting to wonder why I'm even paying my insurance premiums.

TOP COMMENTS  
November 16, 2012

Thanks to tonight's Top Comments contributors! Let us hear from YOU
when you find that proficient comment.

From DRo:

This comment by milkbone pretty much sums up Republican thought.
From Tamar:
This comment from Winston Sm1th sums up the problem the Catholic Church has in applying its principals in a way that sanctions only progressive/liberal members of the church.
From lineatus:
chrississippi cracked me up in seishin's diary about the Taliban accidentally sending a press release and showing the whole "to" list.
From N in Seattle:
BiPM reminded us in C&J that Saturday is Howard Dean's birthday, and there were dozens of comments that extolled his influence on us and reminded us of our abiding love for the man. But by far the most powerful of those comments was iglarmobley's story of how Howard's influence is passed to the next generation.

TOP MOJO
November 15, 2012


(excluding Tip Jars and first comments)

Got mik!


1) Republicans hoisted by their own hypocrisy by ontheleftcoast — 249
2) CBS joins the smackdown by greendem — 215
3) I'm a lucky guy. by Broke And Unemployed — 211
4) I'm OUT!! by The Baculum King — 206
5) Yes, I'm Back, Sort Of by The Baculum King — 203
6) Soledad is one of the few on CNN that have any by Phil S 33 — 195
7) Good, but I want to expand this beyond McCain. by SantaFeMarie — 190
8) If it's a case of one franchise owner by entrelac — 157
9) Good champagne is also threatened by ontheleftcoast — 150
10) I don't think I have ever seen you have quite as by Susan from 29 — 143
11) Beautiful! by PowWowPollock — 139
12) Brilliant! by Gooserock — 133
13) Perhaps he will suspend his campaign to deal with by MrJersey — 132
14) A variation on that old Texas saying: by kenosha kid — 126
15) My thoughts exactly by Dave the pro — 125
16) Republicans just can't accept by jfromga — 119
17) The real reason I didn't win the lottery is that by james321 — 119
18) My son's partner bought her restaurant by global citizen — 118
19) Can't Babysit This Thing by The Baculum King — 105
20) Excellent!!! by TomP — 102
21) talking filibuster by ksp — 101
22) She is one of the few ANYWHERE that still by voracious — 99
23) He owns 40 Denny's franchieses by blueoregon — 97
24) I think now that the idea that its ok for a by HoundDog — 97
25) Black people! In Maine! by Nowhere Man — 92
26) Happy to see you back. by Otteray Scribe — 91
27) Not that I'm an expert on entrepreneurship, by Greasy Grant — 91
28) I like that term - "Dirty Weather".   by lineatus — 90
29) i hope he does by Cedwyn — 88
30) Welcome and thank you for all your work. by blueoasis — 85

TOP PHOTOS
November 15, 2012


Enjoy jotter's wonderful PictureQuilt™ below. Just click on the picture and it will magically take you to the comment that features that photo. Have fun, Kossacks!

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