Tag Archives: health insurance

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…