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The Rick
11-15-2005, 08:23 AM
I'm sure you could make a case for any kind of insurance provider, but today, I'm specifically focused on health insurance. United HealthCare to be exact.

Earlier this year, my wife was having problems with her wisdom teeth. They should have been removed years ago and this year, she finally got it done. They were deeply impacted and they put her out when they did it.

After the procedure, the insurance company comes back and says it's not covered at all. We owe ~$1500. Our policy clearly states that wisdom tooth extraction is covered. The reason it initially wasn't covered? Because the bill didn't include the words "wisdom tooth". It only included the tooth numbers that represent wisdom teeth which as far as I know is STANDARD ACROSS THE INDUSTRY!

So, I got the doctor's office to send a new bill with the words "wisdom tooth" on it. The insurance company comes back and covers everything except for ~$425 worth of anesthesia. I call them about it and they first say, that it must be some mistake because of course anesthesia is covered. They were going to make the correction and call me back within 48 hours to confirm.

After a week of not hearing back from them, I call. They tell me that the anesthesia is NOT covered because it was "deeply sedated anesthesia", although they can't seem to give me an exact definition of what that is.

I'm guessing though that what they mean is if you want your wisdom teeth removed and you use United HealthCare, you better be awake when it's done.

For those of you who have had it done, is that common? Is it common to be awake when having your wisdom teeth removed?

I think this has been the worst experience I've had with an insurance company. Telling me they'll call me back and then not following through, trying to give me the "I'm going be a sarcastic, ruthless b**** but sound pleasant while doing it" voice, etc.

:cuss:

[\rant]

Saulbadguy
11-15-2005, 08:25 AM
It is sad that healthcare is so expensive.

Cochise
11-15-2005, 08:31 AM
Dear lord, we don't want to return people to the days of back alley wisdom teeth extractions :shake:

Lzen
11-15-2005, 08:36 AM
Insurance companies are da debil.

chief52
11-15-2005, 08:38 AM
It is sad that healthcare is so expensive.

It is sad that it is so expensive, but so much sadder that it fights you on every turn to cover anything!!! That is the part that pisses me off the most. Fortunately I have coverage through my employer so I am fortunate. But every year that " same coverage" has gotten worse and worse. They will not cover sh@t unless you fight, fight, fight. I am convinced that they know they should pay certain things but refuse to just to see if you will put up a fight.

Garcia Bronco
11-15-2005, 08:44 AM
I'm sure you could make a case for any kind of insurance provider, but today, I'm specifically focused on health insurance. United HealthCare to be exact.

Earlier this year, my wife was having problems with her wisdom teeth. They should have been removed years ago and this year, she finally got it done. They were deeply impacted and they put her out when they did it.

After the procedure, the insurance company comes back and says it's not covered at all. We owe ~$1500. Our policy clearly states that wisdom tooth extraction is covered. The reason it initially wasn't covered? Because the bill didn't include the words "wisdom tooth". It only included the tooth numbers that represent wisdom teeth which as far as I know is STANDARD ACROSS THE INDUSTRY!

So, I got the doctor's office to send a new bill with the words "wisdom tooth" on it. The insurance company comes back and covers everything except for ~$425 worth of anesthesia. I call them about it and they first say, that it must be some mistake because of course anesthesia is covered. They were going to make the correction and call me back within 48 hours to confirm.

After a week of not hearing back from them, I call. They tell me that the anesthesia is NOT covered because it was "deeply sedated anesthesia", although they can't seem to give me an exact definition of what that is.

I'm guessing though that what they mean is if you want your wisdom teeth removed and you use United HealthCare, you better be awake when it's done.

For those of you who have had it done, is that common? Is it common to be awake when having your wisdom teeth removed?

I think this has been the worst experience I've had with an insurance company. Telling me they'll call me back and then not following through, trying to give me the "I'm going be a sarcastic, ruthless b**** but sound pleasant while doing it" voice, etc.

:cuss:

[\rant]

Is this through work or personal? Do you have an agent? If you have an agent....get them involved...if it's through your company...then contact them as well.

jspchief
11-15-2005, 08:48 AM
It is sad that it is so expensive, but so much sadder that it fights you on every turn to cover anything!!! That is the part that pisses me off the most. Fortunately I have coverage through my employer so I am fortunate. But every year that " same coverage" has gotten worse and worse. They will not cover sh@t unless you fight, fight, fight. I am convinced that they know they should pay certain things but refuse to just to see if you will put up a fight.Yep. It's like it's company policy to reject everything, and then see who's willing to fight to get it covered.

Lzen
11-15-2005, 08:50 AM
It is sad that it is so expensive, but so much sadder that it fights you on every turn to cover anything!!! That is the part that pisses me off the most. Fortunately I have coverage through my employer so I am fortunate. But every year that " same coverage" has gotten worse and worse. They will not cover sh@t unless you fight, fight, fight. I am convinced that they know they should pay certain things but refuse to just to see if you will put up a fight.

Yup. It's the same here.

Demonpenz
11-15-2005, 08:50 AM
unfair claims settlement hotline

Brock
11-15-2005, 08:50 AM
Sometimes prepaid legal is worth it.

Fire Me Boy!
11-15-2005, 08:57 AM
It's not uncommon to be awake when they're pulled, but that's for a straight-forward extraction. Mine were deeply impacted like you wife's and they had to put me completely under to cut them out, too. My wife had them done and they just pulled her's out, not much different that pulling a normal tooth. It's not common to be completely sedated, but it's not uncommon.

FWIW, my bill was just under $500 after insurance. They wouldn't cover my "deep sedation" either, and I fought, too... good luck!

Garcia Bronco
11-15-2005, 08:58 AM
Yep. It's like it's company policy to reject everything, and then see who's willing to fight to get it covered.

That's not true

jynni
11-15-2005, 09:00 AM
For those of you who have had it done, is that common? Is it common to be awake when having your wisdom teeth removed?
From what I can remember, if you want them to completely knock you out for the extraction than you have to up the $$$ for it. At least that's the way my insurance was - my parents paid the extra money for me to be put out completely.

From what I've been told, most insurance usually only covers local anesthesia (or whatever it's called) and I think "laughing gas" - the complete knock out (is that general anesthesia?) is out of pocket.

Garcia Bronco
11-15-2005, 09:04 AM
From what I can remember, if you want them to completely knock you out for the extraction than you have to up the $$$ for it. At least that's the way my insurance was - my parents paid the extra money for me to be put out completely.

From what I've been told, most insurance usually only covers local anesthesia (or whatever it's called) and I think "laughing gas" - the complete knock out (is that general anesthesia?) is out of pocket.


That would be NO2...we're alos talking about dential coverage and not health coverage. Dential is not typically a pervaisve type of coverage. Dential surgery has all types of limitations.

jspchief
11-15-2005, 09:08 AM
That's not trueNo shit?

It's not true in a literal sense, no. But there are a lot of times where you can get something covered if you spend enough time on the phone. That begs the question "Why wasn't it covered in the first place?"

Garcia Bronco
11-15-2005, 09:12 AM
No shit?

It's not true in a literal sense, no. But there are a lot of times where you can get something covered if you spend enough time on the phone. That begs the question "Why wasn't it covered in the first place?"

Because they're not just going to give away money...and no business is going to operate at a loss. If you ran an insurance company you'd scrutinize claims as well.

Fire Me Boy!
11-15-2005, 09:13 AM
From what I can remember, if you want them to completely knock you out for the extraction than you have to up the $$$ for it. At least that's the way my insurance was - my parents paid the extra money for me to be put out completely.

From what I've been told, most insurance usually only covers local anesthesia (or whatever it's called) and I think "laughing gas" - the complete knock out (is that general anesthesia?) is out of pocket.
On the deep impacted teeth, I don't think you have a choice. They certainly didn't ask me (not that I wouldn't have said 'Knock me out').

jspchief
11-15-2005, 09:19 AM
Because they're not just going to give away money...and no business is going to operate at a loss. If you ran an insurance company you'd scrutinize claims as well.Really? They aren't going to give money away? The nerve.

It's one thing to scrutinize claims. It's something entirely different to reject a percentage of claims that you would pay if the customer is responsible enough to pursue it.

If you don't think it happens, then we'll just have to disagree.

Make sure and insert some assinine comment in your response.

Fire Me Boy!
11-15-2005, 09:28 AM
Really? They aren't going to give money away? The nerve.

It's one thing to scrutinize claims. It's something entirely different to reject a percentage of claims that you would pay if the customer is responsible enough to pursue it.

If you don't think it happens, then we'll just have to disagree.

Make sure and insert some assinine comment in your response.
I'll give it a try for Garcia Bronco...


No they aren't going to give money away. They scrutinize the claims and if it's worth paying they will. Trust them.

Jake Plummer plays like he's the love child of John Elway and Joe Montana! Except he's better!




This ends the Garcia Bronco portion of our broadcast. We now return you to your regularly scheduled program.

Garcia Bronco
11-15-2005, 09:39 AM
Really? They aren't going to give money away? The nerve.

It's one thing to scrutinize claims. It's something entirely different to reject a percentage of claims that you would pay if the customer is responsible enough to pursue it.

If you don't think it happens, then we'll just have to disagree.

Make sure and insert some assinine comment in your response.

If your coverage specifically excludes a type pf claim then why would they pay it? Look at your coverage before you go off making claims.

The Rick
11-15-2005, 09:44 AM
One of the things regarding this is that I've looked through the policy and don't see anything about them not covering "deeply sedated" anesthesia. Do I have a shot at pursuing that angle?

Basically, it just reads:

"Coverage for symptomatic fully bony impacted wisdom teeth"

It says nothing about anesthesia in that section. There is a section on anesthesia, but it says nothing about this. I've also checked the "what's not covered" section and have found nothing there either.

chief52
11-15-2005, 09:46 AM
If your coverage specifically excludes a type pf claim then why would they pay it? Look at your coverage before you go off making claims.

I am talking about coverage that expressly covers a specific item. You turn in for it and the insurance company refuses to pay. You get on the phone...get the run around...waist a half of day talking to assorted idiots before you get to someone with a half a brain...and low and behold, " We are sorry, Mr Doe. You are covered for that item. I am so sorry for the inconvenience. I will take care of it immediately." That infuriates me and it is a common practice in the insurance industry.

No one is asking for coverage on an item that is not covered. Get a clue.

jspchief
11-15-2005, 09:53 AM
I am talking about coverage that expressly covers a specific item. You turn in for it and the insurance company refuses to pay. You get on the phone...get the run around...waist a half of day talking to assorted idiots before you get to someone with a half a brain...and low and behold, " We are sorry, Mr Doe. You are covered for that item. I am so sorry for the inconvenience. I will take care of it immediately." That infuriates me and it is a common practice in the insurance industry.

No one is asking for coverage on an item that is not covered. Get a clue.Exactly. It's not about them not paying what they aren't supposed to pay. It's about them trying to get away with not paying what the are supposed to pay.

And if you don't think it happens, wait until you have a baby. We've probably saved ourselves close to $500 by calling insurance companies to call them out on their mistakes in my duaghter's first year. You can imagine that there is at least a small portion of people that didn't know to make those calls, and the insurance company pockets an extra $500 for each of their children. Free money.

Garcia Bronco
11-15-2005, 09:55 AM
One of the things regarding this is that I've looked through the policy and don't see anything about them not covering "deeply sedated" anesthesia. Do I have a shot at pursuing that angle?

Basically, it just reads:

"Coverage for symptomatic fully bony impacted wisdom teeth"

It says nothing about anesthesia in that section. There is a section on anesthesia, but it says nothing about this. I've also checked the "what's not covered" section and have found nothing there either.

Then you have an argument. Have you contacted your agent or company?

Garcia Bronco
11-15-2005, 09:56 AM
I am talking about coverage that expressly covers a specific item. You turn in for it and the insurance company refuses to pay. You get on the phone...get the run around...waist a half of day talking to assorted idiots before you get to someone with a half a brain...and low and behold, " We are sorry, Mr Doe. You are covered for that item. I am so sorry for the inconvenience. I will take care of it immediately." That infuriates me and it is a common practice in the insurance industry.

No one is asking for coverage on an item that is not covered. Get a clue.

I've never met anyone that's had this problem and I work for an insurance agent.

Iowanian
11-15-2005, 10:00 AM
This year, I had 2 prescriptions.......both were rejected by Insurance. I had to fight round and round and prove medical history to have them covered.(they blamed everyone who takes nexium @ $4/pill that doesn't need it)....which had nothing to do with me, since it wasn't that drug I was prescribed. Eventually, I got it paid.

We had a significant life event this year, and I'm still fighting on occasion to get them to pay items covered in the policy.

jspchief
11-15-2005, 10:01 AM
I've never met anyone that's had this problem and I work for an insurance agent.Most people wouldn't go through an agent to rectify this sort of thing.

You'd either go directly to your insurance company, or through your employer (the source of most people's insurance).

Garcia Bronco
11-15-2005, 10:03 AM
Most people wouldn't go through an agent to rectify this sort of thing.

You'd either go directly to your insurance company, or through your employer (the source of most people's insurance).

Well that's what an agent is for...put them to work.

jspchief
11-15-2005, 10:08 AM
Well that's what an agent is for...put them to work.Besides the fact that you totally concede my original point, that you have to go to battle just to get what's due, you also ignore that a large majority of people get their health insurance through their employer rather than an agent.

beavis
11-15-2005, 10:10 AM
It's been a while back, so I don't remember exactly, but I want to say it cost me like $200 out of pocket to have mine pulled. I don't remember feeling like I was being scammed or anything.

I definately recommend having them knock you out though. I didn't feel a thing.

chief52
11-15-2005, 10:11 AM
I've never met anyone that's had this problem and I work for an insurance agent.

You are either not telling the truth or you are totally clueless, I am not sure which. This is a common practice in the insurance industry. Many, many times people get things paid for after wasting valuable time on the phone. It happens all the time. If you want the insurance company to pay what they are binded to by contract, you can not just submit the paper work once and expect proper payment. You have to follow up, follow up, follow up. This is not an accident.

Garcia Bronco
11-15-2005, 10:17 AM
Besides the fact that you totally concede my original point, that you have to go to battle just to get what's due, you also ignore that a large majority of people get their health insurance through their employer rather than an agent.
Sometimes you will have to get on the horn and fight for a claim...that's just how its going to be....but the notion that they blanket deny claims is Grisham related nonsense.