Insurance Rules--FUBAR

[Spiky Bugger]

For those of you without a military background, FUBAR stands for ****** Up Beyond All Recognition. (The VietNam era equivalent of SNAFU.)

So go figure. Dental Insurance. I had to have an extraction...first time since my wisdom teeth came out in about 1966. It was #31, on the last molar on the right side. Tooth in front, #30 has a crown. I therefore need an implant. That comes in two parts, the surgery for the implant and the crown on top. It requires a six-month waiting period after the extraction.

Insurance won't pay for the implant part, but will pay for the crown part. Okay. Pretty standard. Except for this part:

SURGICAL PLACEMENT OF IMPLANTS IS NOT COVERED. THE PROSTHETIC APPLIANCE PLACED OVER THE IMPLANT WILL BE CONSIDERED IF THE TOOTH WAS EXTRACTED WHILE INSURED WITH THIS GUARDIAN PLAN AND SUBJECT TO ALL OTHER PLAN PROVISIONS.

On July 1st, the employer will...or will not...change insurance carriers. If they do, the new policy will also not pay for anything that STARTED under the old policy. And we won't even be told if we have the chance to stay with this policy until late April.

It seems that the now prohibited "pre-existing condition" ******** from medical insurance has not yet been outlawed for dental insurance.

Fuckers.

 

[Spiky Bugger]

PS---the other appropriate acronym is BOHICA! which means, Bend Over, Here It Comes Again!

 

[DianaCox]

Get SOMETHING done/started by June 30th - have your DDS order the crown to be made by the lab, even if it can't be place until later. You incur the obligation to pay (and the insurance incurs the obligation to pay) before the plan changes. You can bill so long as SOMETHING is done.

I got my front teeth prepped for crowns a week ago. I paid a $2500 down payment on the work and have already gotten my FSA reimbursement for that.

 

[Spiky Bugger]

Get SOMETHING done/started by June 30th - have your DDS order the crown to be made by the lab, even if it can't be place until later. You incur the obligation to pay (and the insurance incurs the obligation to pay) before the plan changes. You can bill so long as SOMETHING is done.

I got my front teeth prepped for crowns a week ago. I paid a $2500 down payment on the work and have already gotten my FSA reimbursement for that.

Well...Mr. Sue's ghost writer created a darn good letter mentioning lousy customer service (from the agency through which we get this policy) and that the policy benefits seemed to exclude coverage for something that needs to be covered.

Within an hour, we got two phone calls. First, the Insurance Benefits Center Director called to explain that the claim will be denied, however IF WE APPEAL, submitting the EOB showing that the extraction was done under this OR THE POLICY IN EFFECT AT THE TIME, then they would pay for it. Seems pretty dumb to have to pay in advance and appeal and have the dentist have to refund an overpayment...but they WILL cover it. (Or the fraction of it they DO cover.)

However, if the little bitch on the phones yesterday had transferred me to the person handling insurance, as I requested...or to the VOICE MAIL of the person who handles insurance, as I requested...or even given me the NAME of the person who handled insurance, as I requested...THAT PERSON (the second call we got this morning) could have told me that the insurance is NOT changing in July. The little bitch is new and will receive a refresher course in how to behave in a manner that leads to a RESOLUTION of member concerns rather than an exacerbation of same.

IOW, much ado about nothing.