Remember like a million years ago, when Peeper had her teeth capped, under general anesthesia, at the hospital?
Yeah, we’re still fighting to get that bill paid.
When we set it all up, the dentist’s office told us that our dental insurance would paid the dentist, and our medical insurance would pay the hospital.
(Note: When I say “our insurance,” what I really mean is “Shrike and Peeper’s insurance” because, oh yeah, I don’t actually get to be on that insurance policy. Fuckers.)
The dental insurance did its thing, but we’ve been getting calls from the hospital for months, about the roughly $2500 for the use of the operating room and the anesthesia.
First, they said that the claim had been denied, so they needed a “letter of medical necessity” from the dentist. When I called the dentist’s office, they said, “Oh, you have Blue Cross, right? Yeah, they do that. They always deny it the first time. We’ll send the letter and it will be okay.”
Twice more the hospital called and asked for that letter, and twice more I requested it from the dentist’s office.
Finally the dentist’s office called the hospital to say “We’ve sent this twice, why do you keep asking for it?” and that’s when they found out that the hospital had gotten the letter the first time. And the second time. And, they’d sent it to the insurance company. And they’d still denied it.
So, I called the insurance company and yelled at someone, who totally agreed with me that, “My God, there’s no way you could’ve done that to a kid that age while she was awake. Of course it was necessary, I’ll send it back through.”
Since then, I’ve gotten two more calls from the hospital asking about the status.
Same as the last time I talked to you. Waiting to hear from the insurance company.
So, tonight, as Peeper and I were walking through Lowes with a roll of vinyl bathroom flooring in our car, the insurance company called on my cellphone to say that the claim is being denied because her policy only covers accidental dental issues. They don’t care whether it was medically necessary or not, if the problem wasn’t the result of an accident, she doesn’t have any coverage.
(Well, it’s not like we gave her cavities on purpose!)
So, now we’ve got to write some sort of letter stating why we think it should be covered and saying that we want to appeal on those grounds, and maybe the appeals department will feel differently about it than the claims department.
I will be calling the dentist’s office tomorrow to discuss it with them, because they are the ones who said “. . . and your medical insurance will cover this. . . ” as though they knew what they were talking about.
Did they tell us that without even checking on the coverage?
I know that at some point either they or the hospital said that Blue Cross “doesn’t do preauthorization” but does that mean that they called and asked for a preauthorization and were told “Oh, we don’t do that. Just do the procedure and file it” without being told “but, by the way, when you do that? We’ll deny it because their policy don’t cover that?”
And why doesn’t the dental insurance cover the hospital and anesthesia, since it was medically necessary, in order to perform the dental work – which they did cover.
Oh, and get this – the bill in question is for the use of the operating room and the actual anesthesia meds and equipment and what-not.
They have already paid the anesthesiologist himself.
So, they are saying that the doctor who knocked her out is covered, but the medications he used to do it, and the room in which he did it are not.
Does this make any fucking sense to anyone?