Wednesday, October 6, 2021

Whose Job Is It?

Oh man! Doctors' and dentists' bills! There's always a subtle or unexpected twist, it seems. I had a dental cleaning last month, and was told by the hygienist, as she looked through my records, that it was time for me to have a full mouth x-ray done, not just the bite-wings. I hesitated, aware of being upsold at every turn and asked, 

"Surely that was already done with the preparations and measurements done for my orthodontic Invisalign work this year?"

"No. That's a whole different set of imaging. Those aren't x-rays."

"Are you absolutely sure?" I asked, still reticent to commit.

"Yes, I'm checking through what you had done, and it shows you haven't had full x-rays done since you started coming here in 2018. It's covered by your insurance, anyway."

"Really? I have very basic coverage. I don't want to have it done if I'm going to be out of pocket. It can wait."

"Okay, I'm checking with your insurance. Oh, yes .. it's okay, it'll be fine - they cover full mouth x-rays every 3 years, and you've been coming to us longer than that, so you're due."

"Ok. I suppose. I'm only going ahead with it because it's covered."

Was I born yesterday? What makes me trust people behind a computer instead of my gut? Granted, I hadn't refreshed my knowledge of my coverage before I went in that day, but I was being told it was okay.

I got a bill last week for $106 stating that I had "exceeded the plan limit for this service" (complete set of radiographic images). I was incensed, and angry, and determined not to pay - yes, I'd received those services, but under false information and under duress!

I spoke to the billing person, asking if it had possibly been coded wrong. She assured me they only had one code for that service, and that I should call my insurance. I felt as if I was being fobbed off and stood my ground, waiting, looking directly at her, immovable. 

"Okay, let me check something quickly then. Maybe you had it done at another dentist's office? That's why we ask that you have your previous records sent to us."

"I haven't been anywhere else! But why does that matter? I've been coming here exclusively for more than 3 years, never having had those x-rays done here, so it HAS to be covered." I was more than a little exasperated, but somehow, I managed to be cool and ... believe it or not, polite (for once).

"Well, some insurances cover it every 3 years, and some every 5, so maybe yours is every 5"

"It's not. The hygienist told me that my insurance would pay for 3 yearly x-rays before we got started."

"Okay, let me check ... hmm, it says here that you can have full x-rays done every 60 months - that's every ... 5 years."

"Huh! I would NEVER have agreed to go ahead with it had I known. I was given false information and distinctly told, through all my hesitation and second-guessing, that my insurance covered x-rays every 3 years. I'm not responsible for this fee. I'm not paying for someone else's mistake."

"Hmm, ok. Let me check with the hygienist and we'll call you back later."

The call came through while I was driving home. They cleared the bill. I'm not liable for any payment. 

I really like their practice - they're knowledgeable, professional, have state of the art technology, and are 'nearby' (by Maine standards). If I hadn't dug my heels in, I could have succumbed to their pushy disinformation, and paid for their error. Upselling sucks. When did health care become a market for upselling services ?????

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