Washington Dental Service – You are on my list

Washington Dental Service…you are on my list.

This post should be prefaced by me saying that I have done complicated medical billing and coding and have worked closely with insurance companies.  I work in healthcare.  Put simply:  I’m not clueless.

And yet, even I get dooped on a fairly regular basis and for that, I put the blame on not only insurance companies but also providers.  (more on that in a minute)

Allow me to tell you a story about how I’m experiencing this first hand:  I was experiencing some intense tooth pain a few weeks ago so I went to see my denstist.  I was seen right away and had films and a flouride treatment.  The dentist examined me and I was on my way.  My tooth is now feeling much better thankyouverymuch.  My dentist, smartly on their part, requires payment at time of service and will file claims on your behalf once payment has been made.  The patient is reimbursed directly by the insurance company.  This protects them from being reimbursed less than was expected but puts the patients in a precarious position.  My dentist is one of the best and I’d never experienced insurance surprises in the past so I happily handed over my credit card grateful to be feeling relief from my toothache (and grateful for no cavities!)

Total cost for everything came to $210.  Imagine my shock when I opened an envelope from Washington Dental Service and found a check for only $40.  Really?!  $40??  There had to be a mistake.

I emailed my dental office and asked why there was a $170 discrepency between what I paid and what I received back citing that, according to my plan paperwork, I was entitled to 2 dental exams per year and was only responsible for 20% of additional costs above the exam and films.

The answer is astounding:  yes, my dental plan does cover 2 exams per year…ROUTINE exams.  The one I had was billed as an ’emergency’ and WDS only covers up to $40 total for that.  Really?  Color me angry.

I expressed my discontent and asked that they refile the claim using the billing code for ‘routine’ since I was due for an exam anyway.  I was unaware that there was more than one billing code for the EXACT SAME SERVICE.

I went back and reviewed my plan paperwork to see if I’d missed the whole ’emergency exam’ thing.  Nope.  I hadn’t because it wasn’t there.  So, even though I had read all my paperwork, the exception was no where listed so there was no way for me to know about it in the first place.  If I had known, I would have asked them to bill ‘routine’ in the first place.

And for this situation, I blame both the insurance company and my dental office.  Insurance company for not even putting the exception in their paperwork.  The dental office for not going that extra half step to inform me that they were not using their normal billing code for this visit BEFORE I got the exam.  Like I stated earlier, I work in healthcare and have done medical billing, coding, and financial counseling.  I have helped people in my situation (actually…before they even got in my situation) for much higher dollar amounts and I can’t tell you how wonderful it feels to see the gratitude in their eyes feeling like they have an advocate.  It doesn’t take a lot of time to research a patient’s benefits and let them know of abnormalities ahead of time and the returns in terms of customer loyalty are huge.  In fact, I believe that patients will be willing to pay more money out of pocket if they simply KNOW that they’re expected to.  The mere fact that you’re giving them a choice does a lot for loyalty.  So, any extra time you have to pay employees to research benefits pays itself back in spades.

We all know that providers are under a mountain of paperwork, have high patient volumes, and are generally overworked.  But we are all overworked.  And suddnely realizing that I’ve just unknowingly given $170 to the insurance companies does not sit well with me.

Insurance companies are beasts.  Their web of codes and exceptions will turn a sane man crazy.  I had another experience similar to this where I had an exam that was billed as ‘surgery’ when it wasn’t…at all.  It was the equivelant of a PAP smear and yet, it was billed as ‘surgery’ which, of course, was not covered by my insurance so I paid the whlole thing out of pocket.

All this merely fuels my fire for wanting to learn all I can about healthcare and eventually hold a high level admin position or find some other way to influence healthcare policy at a high level.  If we can put a man on the moon…we can give people important information about their health coverage ahead of time.

What about you?  Any horror stories?  Any stories with happy endings?


~ by fluvial on December 7, 2011.

5 Responses to “Washington Dental Service – You are on my list”

  1. I once had a 20-minute consult with someone I was told was a nurse about how to proceed with surveillance for breast cancer. I did not have breast cancer but had a family history.

    I got billed $800 for this 20-minutes in which she told me not much more than I needed 1 mammogram and 1 MRI per year, along with doing self breast exams. Someone could have passed me the info on a 3X5 card.

    I was not told when I scheduled or signed in to the appointment at Swedish that the nurse delivering the consult (she does this regularly) was actually a contractor and NOT covered by my insurance as all the other people I interact with at Swedish generally are.

    That was $400. $400 for a nurse to talk to me, not perform an exam, no X-rays, no blood work, no other services. We just talked.

    I was then charged $400 for “Room rental”. $400 to sit in a non-exam room for 20-minutes.

    At no point in the preparation or during the appointment was I warned about ANY OF THIS.

    I was eventually able to get the insurance to cover part of the nurse’s fee, and then I got Swedish to remove the room charge after 2 letters to Swedish and several phone calls.

    The whole situation was incredibly infuriating.

    • That is crazy!! I’m so sorry you had to deal with that. I know of the system at Swedish and the only thing I can think of is that you visited the hospital instead of the clinic system? There are actually two different arms of Swedish: hospital and clinic and they have wildly different fee schedules. I get so upset when I hear stories like this because it speaks to the divide between patients and medical practitioners. When everyone’s goal is health…why not communicate better? (meaning, why do health care facilities keep necessary information regarding billing) so secret?

      Gah. I hope you’re having better experiences now!

  2. You already know mine but I’ll share it anyway for everyone else. I called my insurance company in advance of getting expensive tests to make absolutely sure they are covered. I was told as long as it was billed as preventative (which it was) and not diagnostic (which it was not) that the testing would be covered 100%.

    Turns out there is no such thing as preventative codes for the test I I told them in advance that I was getting. Only diagnostic codes exist so I had to pay an unexpected percentage out of pocket after they told me I wouldn’t have to if it was billed as preventative. And who can afford out of pocket medical expenses when your monthly health insurance premiums are $455 per month!?

    Thank you Lifewise of Washington for tricking me into believing you would pay for the test. Had they been honest with me I could have gone to a free clinic to get the test.

  3. Maybe part of these ridiculous problems are just what they bill with. They probably need new dental software ha…but here is my “horror story”. Not dental, and not too bad, but I had a hernia back in high school. We got to the hospital on time, but the surgeon was behind, so I had to wait in the pre-surgery room/area (whatever it’s called) for about 4 or 5 hours. After all was said and done, we were billed for the time that we had to wait there, which was the hospital’s fault. My dad was furious, and went to great lengths to make sure they finally reimbursed us for that, which they thankfully did. But it was one of those dumb things that medical places seemingly try to do to dupe customers.

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