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the dredwerkz

The story begins last August, when I was deciding which health insurance plan to enroll in. When weighing the benefits, I was charmed by the fact that one company (which starts with A and ends in etna) offered preventative dental benefits as part of the package. Not that I love going to the dentist; I just think it's important, and it's even better when it's free... which it was supposed to be. In theory.

In practice, I went to the dentist's right before Christmas. I confidently presented my card, stamped with a big "DENTAL PPO" right across the top, to the receptionist. Smiling, she photocopied it and handed it back. It wasn't until I was seated in the chair, after the x-rays, that she came in to tell me that after speaking with the company, she was sorry to tell me that I didn't actually have dental insurance after all.

Being rather powerless at the time, I wasn't one to argue with the receptionist (I am not the most confrontational person as a rule). However, upon returning home, I duly called up the customer service reps who curtly informed me that the receptionist had been correct: there was no record of me ever having any kind of dental insurance, despite the fact that it was cheerfully listed in the "Explanation of Benefits" booklet I had received (and kept, just in case - or when - problems appeared). They told me to contact the HR person at my workplace.

The HR person at my workplace is not the easiest person to call, unless you're AT my workplace, which I, on a daily basis, am not. I'm only there once a month. So I saved up my problem for the last visit, and was able to explain my problem several times to several different HR people, each time with a captive audience of about 10 of my co-workers (I don't so much work in an office as in a large room). I was finally asked by a woman at the health insurance company why I was having problems, as the kind of health insurance I chose included full preventative dental benefits. It was at this time that I first became truly thankful for the fact that I am unfailingly polite.

After assuring her that there was indeed a problem, and despite the fact that she, and now the majority of my co-workers, know that I have dental benefits included as part of my health insurance, I still had to pay $170.00 out-of-pocket right before Christmas for dental care that I should never have had to pay for.

She understands, is insincerely appalled, and offers to submit the claim for me. It's processed. Yesterday, I received a check reimbursing me...

... for $143.00.

I called the dentist. According to them, $143.00 is the negotiated fee agreement, which means that, had the dental insurance shown up the first time I went in, the dentist would only have been reimbursed $143.00 by the insurance provider (after I paid nothing, which is why I paid for insurance in the first place). In plain English, it means that when after reading on the paperwork "PLEASE CONTACT THE PROVIDER FOR REIMBURSEMENT OF ANY AMOUNT YOU PAID IN EXCESS OF THE NEGOTIATED FEE..." it should continue "...SO THEY CAN TELL YOU TO GO SCREW YOURSELF (which they did), YOU'RE OUT TWENTY-SEVEN BUCKS."

So the question remains... how do I get my twenty-seven bucks back? Time to call Chuck Norris....

posted at: 2006-01-31 16:41:16 with 1 comments

Comments

I WANT MY TWO DOLLARS | edward

sorry to yell. but, hey, deborah, happy birthday!

perhaps some kind soul will assist you on this day with your need!

posted at: 2006-02-01 08:09:20
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