Thursday, July 23, 2009

Through the Looking Glass (Where Illogic is the Norm)

It all started several months ago during a routine visit to the dentist’s office for a cleaning. They did some x-rays and the dentist told me it was time to replace a 20-year-old crown. It wasn’t urgent, so I scheduled an appointment a couple months later.

A week or so before the first of the two appointments necessary to get a new crown, I got a letter from the dentist’s office saying they were going to expect me to pay a thousand bucks for the crown. Hmm….a thousand bucks. My wife has been holding off on a non-urgent crown replacement from the same dentist….she got a letter…I found it in the file….830 bucks was her estimate.

So I called the dentist’s business office and asked why my crown would be 170 bucks more. What followed was the most convoluted non-explanation you can imagine, having to do with “rates”, “reimbursements”, “deductibles” and all that other medical insurance jargon. What I took away from the conversation was that my crown would cost 830 dollars out of my pocket, same as my wife’s.

The first appointment, the “long” one, where they pry off the old crown, clean up the remaining surface of the tooth, and take the impression for the new crown, went swimmingly. They took me back to the chair at exactly the appointed time, and 38 minutes later I was on my way home, with instructions to be careful with the temporary they’d put in, till the next appointment in two weeks.

Just before the second appointment, to install the new crown, I got a letter from their business office reminding me that I should be ready to pay a thousand bucks when I came in to get the new crown installed. Another call; another “oh, that’s just our standard procedure”. I asked how much money I had to pay, in total, to satisfy the bill. Answer: 830 bucks.

So I went to the second appointment, they put in the new crown (which fit like a charm!) and I paid the 830 bucks. Three days later, a bill arrives from the dentist’s office, telling me I need to send them a check for 170 bucks to pay the bill in full. It clearly said “your insurance has paid its portion, and you are responsible for the balance”.

Another call, another trip into the alternate reality of medical billing. No, I really don’t need to send them 170 bucks. So why did they bill me? Oh, it’s their “standard procedure”. They’re sending a similar bill to my insurance company to pay it, so I can just “disregard” the bill they sent me.

Say what???? You sent me a bill you don’t expect me to pay, and nowhere on it does it say you’re sending the same bill to my insurance company - while the bill itself says my insurance company has already paid? Oh, that’s just our “standard procedure”. Deductibles, co-pays, agreed prices, billing cycles, more medical billing mumbo-jumbo is what I got.

Do you see the scam here? How many people do you suppose pay that second bill, who never bother to make a call or ask a question about what they’re paying for? As far as I’m concerned, the quality of dental care that I got was absolutely top-notch. The quality of their billing procedures borders on criminal. It’s beyond stupid, it’s downright dishonest.

So don’t tell me we need to slow down on health care reform. I’ve learned a long time ago that you have to be a strong advocate for your own health care; you have to argue with insurance companies; and you have to be alert for billing mistakes and outright scams. We need reform NOW.


  1. Well, hold on old horse! Look, out there, on the horizon, in the year 2013 it's the Obama Plan! It's coming to save some of us, course your billing cadre will be the same. Slightly less overhead from 20% to maybe 11% not the 3% medicare cost we were promised. But bigger co-pay and deductable should cover that loss.
    Remember, Pres.Johnson signed the Medicare law in July 30, 1965 eleven months later it was up an operating in eleven months coverring 45 million seniors with a non-profit government program. Why the delay untill after the election?

  2. It's way too easy to game the current health-care delivery system. Dr. Fraudster lightens your poke for an extra $170 and his chances of getting caught, let alone punished for stealing such a relatively petty amount are nil. If his extra bill is questioned, well ... it's just one of those pesky billing errors. The rules are Sooo complicated, you know.

    Who knows how much the cheaters and thieves add to the cost of commercially available health insurance? It must be substantial, and it's so difficult to prosecute them because the burden of proof is high and the amounts of each grab are not huge and the checks are coming from all over the place.

    Pull that same sort of fleece job on a single-payer federal system a few times and the fleecer could end up cleaning toilets with Bernie Madoff.

    Medicos do try to loot Medicare; It's a constant and expensive problem. But there are no really new scams under the sun, so in the long run it rarely turns out well for them.