The black hole of health insurance

I just got back from the dentist where I had my bi-annual cleaning. Everything’s fine; apparently I do a good job with my “home care.” While I was there, though, I asked about a spot at the top of one of my front teeth that is slightly discolored. I don’t think you’d notice it during normal social interaction, but I do, every time I brush my teeth, or look in the mirror with my lips pulled back, which I do in order to stare at the discolored spot.

I asked the dentist about the spot and he said, “I can fix that.”

He went on to explain that it’s a spot that’s decalcified and isn’t medically problematical, although, if it got worse down the road, it could be. I didn’t need to do anything about it, but if I wanted to, no problem.

I’m not terribly vain, but come on, it’s one of my front teeth. It’s tempting to get it fixed. But wait, I asked, isn’t that cosmetic? Insurance wouldn’t pay for it, would they?

“Oh yes they will,” he said. “It’s all in the insurance code.” Then, with a wink, “It’s a filling.”

And there you have my dilemma. I can have this spot fixed if I knowingly participate in a mini insurance scam. What else can I call it?

I’m astonished and appalled at how little we consumers know about how insurance works. One of our household has been seeing a particular specialist every two weeks for months now. Each time, we write a check for the thirty dollar co-pay. We have never seen a statement from our insurance company about this doctor. When I asked the secretary how much an office visit was, she said it depended on a few factors, but ranged from $195 up. Really? There isn’t a set office visit fee? How much is this costing the insurance company?

In this particular instance, we don’t have a choice. We’ll keep seeing this doctor until they resolve the problem. But invisible charges? I’m much less comfortable with that than I am with the idea that the dentist can code a procedure as a filling so I can have something fixed that I wouldn’t pay for otherwise.

Maybe the insurance industry is rigged to be one big, cosmic, balancing act; my conscience might keep me from taking advantage of my dentist’s offer because I’m angry that the real cost of our health care is hidden from us. If that’s the case, then in the end, I’m the one who loses.

I once called a doctor’s billing office when the paperwork from the insurance company listed several procedures I didn’t recognize. They said, “There aren’t really codes for what you had, so we picked the closest ones.”

Really? So not only does the insurance company not know the truth, but now I have no record of what was done to me because believe me, when they say they picked the “closest” codes, they mean they picked things that look totally unrelated.

I know I can’t change any of the bizarre machinations of the health insurance industry. I do, however, need to make a decision about that little, discolored spot. Would it be wrong to have it done? It is one of my front teeth…


14 responses to “The black hole of health insurance

  1. Pingback: Judy Mintz: The black hole of health insurance « NESCBWI Kidlit Reblogger

  2. One of our dentists actually ended up spending time in jail (6 mos.) — lost his license for awhile and nearly his practice — for doing a patient such a favor. A disgruntled employee ratted him out. I probably would never have known but happened to be in court for the sentencing of our friendly neighborhood burglar, and the dentist’s insurance fraud case was up first… Couldn’t figure out where I knew “the defendant” from, he looked so darned familiar, so I strained my ears to listen to the details of the case. When the coin dropped I actually punched MY prosecutor in the arm and blurted out, “OMG, that’s my dentist!” (I wonder if he ever thought one of his patients might be in the courtroom…)

  3. OMG…it’s such an amazingly fine line. Isn’t it? I always used to quip that health Insurance should really cover such things as face lifts, hair implants, and (within reason) breast implants. Why? Well, they pay not only for childbirth, but also for FERTILITY…helping the non-pregnant get pregnant. I ask you — if you work w/ the public, or interview for a job in, say, sales or marketing — which will help you be a better employee: kids or looking younger and more attractive?

    The only way kids helped me as an employee was because I was a single mom and had to support my kids. So I worked very hard, and was terrified of losing my job because I had no backup support.

    However….if you consider elective or aesthetic surgery, almost every exec. I know makes sure they get the face lifts, botox (record number of men now doing Botox), hair work, tummy tucks, and any elective surgery available BECAUSE IT HELPS THEM STAY AT THE TOP OF THEIR GAME! And, arguably IN THE GAME! Ironically, those w/ these jobs can afford to pay out of pocket. Those who are unemployed, can’t, yet they really need to look their best (and their youngest) for the interviews in this job market.

    Just yesterday, i heard that the unemployment rate for those ages 50 – 65 have reached a record high, and the length of unemployment is nearly 2 years, and growing. A company you and I both know laid off 10 women over the age of 50 within the same few weeks. I guessed that the cost of corporate health care was a motivating factor.

    If I was a health care provider for a public company and/or large corporation, I’d offer a much better deal to a company w/ an average age of, say 30, rather than 45. So, no matter how much the company might value your work, as soon as you start to tip the scales that might raise the cost of health care, there would be an obvious incentive to let you go.

    If you are looking for another job, if your husband likes to see you look your best, or even if you suddenly become single at age 50+ and would like to date again, you better get that tooth fixed. I’m not telling you to cheat health care. Or rob a bank. Why not try “KickStarter.” You’re a talented writer who probably has a chance of getting published. You could pitch the angel investors on KickStarter that your smile needs to look good for your upcoming book jacket! And kudos for your ethics.

    • Your comment is a great post on its own. But let me boil it down, you’re saying “no,” I shouldn’t let him invoice it as a ‘filling.’

  4. I’m not saying, Judy. I suppose I would say it depends on how much you are paying for health care, and if you are using it a lot. If you haven’t had a filling in years, and you pay for dental coverage….I suppose I might be able to rationalize as follows: You’re paying for an average of # fillings per decade. if you look at it as “cost for a service” vs. WHICH specific service you get….as long as you remain in your allotted budget, it seems reasonable that you get to take advantage of your dental “allowance.”

  5. Like many industries, insurance is cobbled together, without good solutions for these kinds of problems. Fraud is rampant, and that drives up costs for the rest of us. (Though, per Dan Ariely’s blog everyone’s at least a little dishonest.)

    Insurance is one of those things I think could be handled much better by co-ops than by for-profit corporations, though that wouldn’t solve the fraud problem.

  6. This is why we need health care reform. I’m not getting on the political horse here but this is a clear example of where people can’t get their health care covered the way it should… It shouldn’t be a crime. It should not be an issue to repair something that could very well become a problem – preventive (defensive) care.

  7. Gosh, I’ve just encountered an honest person. Black spot or not, I think you’re swell. I sound like a 1930’s movie, don’t I? But you’re so right when you say we don’t understand this system. I had to get a small tube of cream for a pre-cancer on my hand. The clerk made an error and rang up the bill as if I were to pay it. I about fell over when she said, “That will be $285.” The tube was about two inches long and less than an inch across. Fortunately, she checked and my insurance covered the medicine. I wonder what they paid?

    Good luck with sorting out your dilemma. I came by from WritesSupport4U to join your blog and say hi. I’m leaving with a few thoughts to mull over. Thanks for the great post.

    • I hope you won’t be too disappointed if I decide to have the tooth fixed. Your story about the $285 cream is incredible. Things like that are why people have to choose between medication and food. Thanks for stopping by.

  8. I’ve been thinking about your post and not sure what my two cents are. Actually, I suspect he will be drilling and filling that spot. So technically it will be a filling–just not one due to decay that is impacting the health of the tooth…yet. Because my guess is the enamel is compromised already if the color has changed. I think the insurance company always wins. They don’t pass the cost on to consumers. They reap huge profits regardless.

    I once went to the ER and declined IV hydration (migraine, didn’t need it by the time they offered it). The insurance company paid for it anyway. When I called to say they should argue the charge because I didn’t actually receive the treatment, they couldn’t be bothered to fight it!

    And I do think dental insurance should pay for some cosmetic work. Poor people can’t get jobs because of teeth missing and such. People with insurance have their teeth filled with enamel that matches so they will look good or at least “neutral.” And poor people should have dental insurance since so many other health problems are linked to gum disease (heart attacks, infections, etc.). So… I dunno. I’d say play the game. The insurance company is playing their version of it. You might as well play back.

    Immoral Annette

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