Step Off The Back Porch, I Need Advice

[Kaneohegirlinaz]

This may sound odd, but here it goes...

For most of the years that my husband and I have been married, I take care of all comings and goings in regards to our health care. ie, if someone needs to deal with an insurance company or a billing office, I do it.

Over the past few years, DH does not do well with even hearing about the heights and depths I've traversed. It has become worse since we've moved to the "mainland". All of our insurance plans: medical, dental, vision and drug, are from Hawaii, not here on the mainland at all.

Dealing with the healthcare providers here on the mainland has been, well let's just say MORE than a challenge, but I've managed to get things done and taken care of.

I have hit a LARGE stumbling block and I'm not sure what to say at this point.
Here's the back story in a nutshell:

Our new dentist's office manager said to me that services that are not being paid for by the insurance company (that they participate with btw) and that the patient is neither responsible for, Doctor will no longer preform for free and therefore this will lead to further, painful procedures, ie. Root Canals.
(I'm guessing you figured out that I'm BEYOND agree.)

SO...

I figure I call her back and say, fine, we'll pay for the "extra charges" out of pocket, BUT, I don't want her or Doctor to discuss this with my husband... He would, um, not take kindly to this circumstance.

How do I say, nicely, please don't talk about this with my husband?


Not sure how to say, can you please just keep this between us...
HELP?!

 

[medtran49]

Have you checked the EOBs from your insurance co to see if they have even billed? We've had at least 2 dental offices outright lie to us and say the insurance Co won't pay for certain procedures, yet when I call the insurance Co they say they will. I think they just don't want to bother with the paperwork or settle for the amount they agreed to accept when they signed on with the company.

You can ask them not to talk to him, but they'll have to note it somewhere obvious on the chart, which he may see. Or, somebody might not see the note and say something.

 

[Kaneohegirlinaz]

Have you checked the EOBs from your insurance co to see if they have even billed? We've had at least 2 dental offices outright lie to us and say the insurance Co won't pay for certain procedures, yet when I call the insurance Co they say they will. I think they just don't want to bother with the paperwork or settle for the amount they agreed to accept when they signed on with the company.

You can ask them not to talk to him, but they'll have to note it somewhere obvious on the chart, which he may see. Or, somebody might not see the note and say something.

Ya med, I always make sure that they submit a Pre-Auth (I use to work in the field ). This office doesn't go online to do business with the insurance company for some odd reason, so I saw on my side that the claim had already been processed, and spoke with our ins. co., they're not suppose to charge us, period. This gal had not gotten the claim yet.
So I thought that I'd give it time to come to them and then re-visit this topic with her again.

I could not have been more PO'd when she spoke right over me, saying that we don't this work for free you know. If your ins.co. doesn't want to pay, then we won't do the work.

Let me also add that it has taken me 6 months to find a good dentist (most of them have crumby front office people btw) in this tiny town, that we've been traveling 3 1/2 hours South to see our old dentist. He said with the amount of work that DH needs to have done, we'd be much better off finding someone up here, "We're a dime a dozen you know".
DH has signed a HIPA or privacy with all of our care givers that they are to speak with me on all matters.

For the life of me, I can't think of how to say:
Don't tell DH about this or he'll hit the roof

 

[Addie]

Ya med, I always make sure that they submit a Pre-Auth (I use to work in the field ). This office doesn't go online to do business with the insurance company for some odd reason, so I saw on my side that the claim had already been processed, and spoke with our ins. co., they're not suppose to charge us, period. This gal had not gotten the claim yet.
So I thought that I'd give it time to come to them and then re-visit this topic with her again.

I could not have been more PO'd when she spoke right over me, saying that we don't this work for free you know. If your ins.co. doesn't want to pay, then we won't do the work.

Let me also add that it has taken me 6 months to find a good dentist (most of them have crumby front office people btw) in this tiny town, that we've been traveling 3 1/2 hours South to see our old dentist. He said with the amount of work that DH needs to have done, we'd be much better off finding someone up here, "We're a dime a dozen you know".
DH has signed a HIPA or privacy with all of our care givers that they are to speak with me on all matters.

For the life of me, I can't think of how to say:
Don't tell DH about this or he'll hit the roof

First speak to the dentist regarding your request. I am sure he wants his money so he can take that vacation to Hawaii next year. Also let the dentist know that DH will hit the roof if he hears about problems with the insurance.

If that doesn't work emphasize those words to the front desk. Let them know that he will raise a ruckus right there in the office in front of other patients. The last thing the dentist wants is to stop when he is with a patient to come out and find out what the problem is. More than likely, he told the front desk about it and told them to take care of it. Tell them you want a note in large bold letters placed on the inside of his folder stating such. Then tell them you want to see the folder yourself. If necessary, print out the notice yourself and bring it with you for them to tape inside the folder. Mr. DH is not have any discussions regarding their insurance under any circumstances. Speak confidently to his wife only. This is one time when being polite doesn't always have a place. You have to be pushy. Even if it is against your nature. Some people are just too dense or overworked to listen or even care what you are saying. Make sure you follow up on your request. Don't trust them to just do it because you said so.

 

[ixamnis]

Be sure to speak to your insurance company regarding this policy. This MIGHT constitute insurance fraud or breach of contract on the part of the dentist. (And it might not).

As an Optometrist, I can tell you that what is TYPICAL is that insurance companies have a contractual arrangement with most doctors stating what the insurance company will pay for a particular procedure and what the patient will pay. Anything else is a write-off for the doctor.

There are, however, some exceptions.

For example, in Kansas, where I live, if a Vision Insurance plan does not pay anything for a particular procedure, they CANNOT (by law) require the doctor to take a discount or write anything off for that procedure, even if their contract states that the patient does not have to pay for it. By law, the patient IS required to pay for it.

So, as I said, first contact your insurance company. If you don't get your questions answered, or if you think the dentist is doing something unethical, contact the State Dental Association, and ask the same questions. In my experience, the associations will be straightforward in answering your questions.

As to your ORIGINAL question (which has little or nothing to do with my response, so far), talk to the office manager about whom to discuss finances with in your household. The office manager should be able to take care of this for you.

 

[Andy M.]

First of all, have the insurance company call the dentist directly. They will straighten it out for you.

Second, consider having a chat with DH and tell him there may be some questions about coverage but that it's all taken care of so ignore it.

Finally, talk to the doctor and the office manager and your requirement they NEVER discuss non-medical topics with DH.

I'm sorry you have to deal with this.

 

[Aunt Bea]

IMO you should tell DH the truth, keep the Dentist and his staff out of it.

Good luck!

 

[Caslon]

Sorry to tangent off,
Dental insurance is brutal. It's almost a gamble whether it's worth it. Most dental plans costing $1000 a year have a $1000 max pay out for that year. A crown costs $1500 easy. Dental insurance is a loss leader, as far as I'm concerned, all in all. It's just a small discount.

Tell us all if 911 is called.

 

[medtran49]

Well, it sounds like they just don't want to accept what they agreed to when they signed on with the insurance company. That's they problem we are having with some work Craig needs done. They want the little monthly fee they get for being your primary dentist (at least I'm assuming that is still how it works, haven't worked in an office in a LONG time, but that's how it worked with medical docs anyway), but they don't want to take the hit elsewhere. When you speak to the OM again after she gets the paperwork and are still getting the same song and dance, I'd be calling the insurance company to let them know.

It's a huge gamble if you try to hide it from him. If he finds out either through seeing it on the chart or somebody does talk to him inadvertently about it, not only will he hit the roof at the office, but then he'll hit the roof with you even worse.

 

[Caslon]

Do you each own a hand gun?

 

[Kayelle]

{{Kgirl}} Since you asked for advice, mine would be to talk with hubby about the problems. So he gets upset..so what? There's no reason you should have to deal with the problems without support from him. Have faith he'll surprise you.

 

[Kaneohegirlinaz]

Special Thanks

... snipped ...This is one time when being polite doesn't always have a place. You have to be pushy. Even if it is against your nature. ...

You know a this little Hawaiian gal too well...I HAVE to be nice to people

Be sure to speak to your insurance company regarding this policy. ... snipped ....

There are, however, some exceptions.

....If you don't get your questions answered, or if you think the dentist is doing something unethical, contact the State Dental Association, and ask the same questions. In my experience, the associations will be straightforward in answering your questions.

As to your ORIGINAL question (which has little or nothing to do with my response, so far), talk to the office manager about whom to discuss finances with in your household. The office manager should be able to take care of this for you.

All very good points I.
I'm not sure if I made mention, that I did work in the field and know the tricks of dental insurance claims as well, contacting the State Dental Association was going to be my next step.

... snipped ...

I'm sorry you have to deal with this.

Thanks for that Andy! But as the song goes, "... it's my job..."

IMO you should tell DH the truth, keep the Dentist and his staff out of it.

Good luck!

I appreciate that Aunt Bea.

Sorry to tangent off,
Dental insurance is brutal. It's almost a gamble whether it's worth it. Most dental plans costing $1000 a year have a $1000 max pay out for that year. A crown costs $1500 easy. Dental insurance is a loss leader, as far as I'm concerned, all in all. It's just a small discount.

Tell us all if 911 is called.

Caslon, we have a very good dental plan from back home in Hawaii.
We're retired State workers, so it's all good.

...snipped ...

It's a huge gamble if you try to hide it from him. If he finds out either through seeing it on the chart or somebody does talk to him inadvertently about it, not only will he hit the roof at the office, but then he'll hit the roof with you even worse.

You got that straight med!

Do you each own a hand gun?

Caslon, we live in the State of Arizona, everybody's got a gun This is cowboy country and it's every man (or woman) for them selves out here!

 

[Kaneohegirlinaz]

Another Special Thanks

{{Kgirl}} Since you asked for advice, mine would be to talk with hubby about the problems. So he gets upset..so what? There's no reason you should have to deal with the problems without support from him. Have faith he'll surprise you.

Didn't see ya there K!!
and you're right about supporting one another, that's called a partnership, a team and that's what we are, come hell or high waters we're in the crazy game called life together

 

[Kaneohegirlinaz]

Dilemma Follow Up

Update:

I called to the Dentist's Office Manager to follow up on the earlier conversation.

Sidenote:
Wasn't it funny that when I called this afternoon, introduced myself and said that I wanted to follow up on our earlier conversation, she had all of the info in front of her, remembered who I was, why I was calling and the exact particulars of the claim BEFORE I even got there, HMMM

... carry on ...

I asked if they had received payment and a EOB from our insurance company in Hawaii ... yes.

I went on to say that we do not want Doctor to NOT preform any procedures that he fells necessary whether the insurance company pays or not, that's not the issue at all.

I also went on to say that my husband has no interest nor patience for this sort of thing. That I have taken care of all of these sorts of matters for many years and it would be best to speak with me and not him. She understood.

BUT WAIT!

The Office Manager informed me that she had taken this matter to the Doctor and he let her know that:

SHE FILED THE CLAIM INCORRECTLY!!!

She had used all wrong coding and so she has sent in a revised claim to our insurance company.
I knew I smelled something funny here!

Lastly, not to toot my own horn,
but then I brought up the fact that she should consider filling all claims via our dental insurance companies DIRECT website... that our ins. co. told me that they were submitting by SNAIL MAIL!

"Oh no, I access XYL.com" (this is a fictitious site, obviously)

Nope, WRONG!!!

It's HawaiiXYL.com
So I walked her through the site and boy, let me tell you, did her tune change!

Ya lady, I DO KNOW what I'm talking about

 

[Andy M.]

That sounds like a great result. Way to go, K-Girl.

 

[Addie]

Someone who made the system work for her!

 

[Cooking Goddess]

...Sidenote:
Wasn't it funny that when I called this afternoon, introduced myself and said that I wanted to follow up on our earlier conversation, she had all of the info in front of her, remembered who I was, why I was calling and the exact particulars of the claim BEFORE I even got there, HMMM ..

Oo, Oo, maybe the office manager is a member here at DC and saw your post. Not likely.

Glad things are pretty much resolved. Nice of the doctor to come to your defense and correct his employee. Maybe a little home-baked treat might be in his future...

 

[Cheryl J]

Just reading through this...wow, great job, kgirl! I'm so glad you stepped up, made your voice heard, and got good results. I second CG's suggestion of a nice little homemade treat for the dentist and office staff.

 

[Cooking Goddess]

But no goodies for the office manager, Cheryl. After all, her ineptitude is what started all of K-Girl's problems.

 

[medtran49]

for the office manager and for K-Girl!