Dental Insurance Nightmare

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If you get health and dental insurance through an employer you are very, very fortunate. I wouldn't wish self-payership on anyone. So arcane and byzantine are the services covered on an idividual policy, that you have to read it once to be appalled, twice to understand it, and three times to believe they are serious.

After spending two months researching the dental plan options for a family of 7, I have now become a real "DC," or "difficult customer," that is, I have been enlightened. So I dread my next visit:


SCENE: Dentist chair; dentist finishes looking into my child's mouth

DENTIST: She definitely has a cavity in one of her baby teeth, but since that's going to fall out this year, I would rather put a preventative sealant on her tooth and watch it until it falls out.

ME: Oh,OK. Is it the same kind of sealant that you put on adult teeth? (Mom is thinking, sealants are covered for second teeth only...hmmm.)

DENTIST: Well, no, it's a stronger coating.

ME: Do you happen to know the code for that? I mean, can you at least tell me if it starts with a 1 or an 8? Because if it starts with an 8, then it's considered an "orthodontic procedure," and my insurance won't pay it.

DENTIST: That I don't know. You would have to ask billing about the code. But it's a common sealant I use in cases like your daughter's.

ME: OK, assuming it's an 8-code, how much would you charge me?

DENTIST: Uh, again, I don't know, you would have to ask billing.

ME: But don't you have, like, a price list for all these things?

DENTIST: (laughing nervously) No, but that's an interesting idea, I should write that down.

ME: Let's skip that for now. What else is going on in her mouth?

DENTIST: There is one other back molar that needs a small filling. I'll get her numbed up, and we'll get started.

ME: Whoa, whoa, not so fast. Which tooth is it, how many surfaces are you talking about and are you going to use amalgam or composite?

DENTIST: (now flabbergasted): Number 19, two surfaces,composite.

ME: No, we can't have that. Fill the deepest surface only, and with amalgam because we're only covered for one surface with amalgam on a back tooth. Her dad and I will watch the other surface pocket, you know, we'll use a magnifiying glass, and we'll floride rise it for 24 months, after which time our insurance will be ready to cover the second surface. Got it?

DENTIST: (just stares)