Dentists and Medicare

Today I decided to write about a recent fiasco with the dental industry especially with regard the handling of new patients and how new patients are treated.

This year my wife and I decided to switch health insurers from the Medicare Advantage program we had in 2014 to a different insurer for the year 2015. While a bit more costly (this plan does not offer a rebate as did the one we had in 2014),  the coverage/co-pays/drug costs and what have you seemed a bit better and thus our reason for switching. Plus, they offered “Dental” insurance which when you are in your seventies may come in handy.

Not having seen a dentist for our annual checkup this year, (new plan – new dentist) we had to call our insurer to (1) be assigned a dentist and (2) arrange for an appointment. But before I go any further, allow me to interject what brought this all about (seeking a new dentist early in the year). Late Sunday afternoon, while eating dinner, my wife discovered that a tooth broke free from her dentures.

So, we got on the phone with our insurer (Medicare Advantage Plan) and learned that the Dental Insurance Plan (Company A for the purposes of this article) associated with our Medicare program had pre-assigned us to a specific dentist within a few short miles of our house. We decided to call them (the dentist) to set up an appointment to have her denture looked at. After what seemed like forever answering this question and that question, we were informed that even though our Medicare Advantage Plan had assigned us this dentist, they were not taking on any new patients. Back to the telephone! Keep in mind this is February 2, 2015, a feature that will prove to be interesting later.

After speaking to our Medicare insurer once again, suffice it to say that they assigned us another dentist but upon calling to set up an appointment with them, learned that even though the first dentist (who was supposed to be our assigned dentist) was not taking any new patients, this next dentist on the list could not see us until after March 1st as you cannot just switch from one dentist to another in the same month (remember now – we haven’t even seen any dentist this year yet). Forget the fact that the first dentist hadn’t even seen us – just because we were assigned to them as of January 1, 2015, and it was now February 2, our plan provider could change us to another dentist but we would not be able to see them until after March 1st (rule of the program).

Call me crazy or what have you but having been in the insurance industry 35 plus years (property and casualty insurance as opposed to health-care insurance), I have learned a thing or two about how the system works. As a result, when I switched to a Medicare Advantage plan now available to many seniors over the age of 65, I decided to keep the dental coverage (Company B) my former employer had because in the beginning many Medicare Advantage Plans did not provide dental coverage. Naturally this costs me extra but it has come in handy over the years.

So, we asked this second dentist if they would check to see if my other policy (Company B) would be valid so that we could see the dentist this month yet, preferably within a day or two. The receptionist said yes and an appointment was set up for the same day. But shortly after hanging up the phone, they called us back to inform us that our Company B program for our dental coverage was an HMO type plan and they (the dentist) only accepted patients on a PPO plan.

Back to square one! During all this melee of phone calls and running around seeing these dentists, we came across a firm that specializes in repairing dentures as well as providing or replacing worn dentures. But………..don’t you just hate it when there is a “but”…they didn’t involve themselves with the insurance end of the business. They see you, tell you what they think you may need, allow you to make the choice, and tell you what it cost. At that time you can accept their offer, have the work done, pay them, and if you choose to – submit a claim to your insurance company for the cost of the service.

That is exactly what we did. We stopped in – they told us what they could do for us and what the cost would be. We had the work done, I paid them and we were on our way. Since it was a repair on a denture that has been in service for years, there was no guarantee how long the repair would last but the fact of the matter is that they did something. They were not bound by rules, guidelines, timetables, and so forth that serve no other purpose than to create a paper nightmare subsequently turning people off to dentists and the overwhelming abundance of red tape, paperwork, and so forth, individuals such as we have to put up with today.

Bottom line and the reason for this rant and rave – is it any wonder why individuals do not like to go to the dentist? First off – for whatever reason many of us have a fear of visiting dentists and then there are situations such as the one just described that tend to drive a sane person crazy and don’t even get me started on some of the prices I have had dentists propose to work on my teeth. That would fill another page.

I am happy to say though that while I am out of pocket the entire cost of what was charged to repair my wife’s dentures, she is feeling better and for the moment all is good in the world again.

Now where is that directory so that I can attempt to determine who it is we are supposed to see when we need a dentist………………. hopefully in this year yet?

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About iglengel

Welcome to my blog: I retired in September of 1996 after twenty-five years as an Underwriting Manager (and one year with a smaller insurance company) and have written blog postings on the website Retirement-online.com prior to setting up this Word Press free site. Having retired almost twenty years ago I have experienced my own retirement transition. I survived and you will too. Oddly enough, now that I have more time, I am discovering various things about myself that I would not have imagined myself doing in retirement. Why does it take so long for, we as individuals, to stop and think about ME!? Join me as I share with you some of the shenanigans we have been up to since retiring. Retirement is and can be a whole lot of fun. Welcome to my site – remember – retirement is not the destination we are seeking – it is the journey! I encourage you to visit often, provide comments, ask questions and add your own insights. We are all on this journey together.
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