Just Because You’re Paranoid….

Well, today was just another one of those days being a parent.  One of my daughter’s permanent teeth is coming in at 10&40 instead of 12&30.  So her dentist sent us to an orthodontist to see if it would naturally fix itself, or if we would end up needing to go to and oral surgeon to manually correct it.  Well, the orthodontist, being an orthodontist, was really pushing braces.  Braces would fix everything.  They would fix things that are not even problems!  They would fix the spaces between all my daughter’s teeth…even though those spaces will naturally fill in through normal migration of teeth during adolescence.  They would fix her extremely slight overbite…which I never heard ever hurt anyone.  And they would use the braces to pull her top front teeth almost an entire tooth-space to the right to try to give her angled tooth more room to descend more up and down.  But they weren’t sure it would work.  How long would we have to wait and see if it worked (and of course, keep the braces on)?  Oh, well, they would recheck the angled tooth after 6-9 months of braces, and if it hadn’t started to correct itself, then we would need an oral surgeon.  But—get this–we would have to keep the braces on to pull the top front teeth back to where they are now, AND, we’d have to go an additional year (to fix the problems that nature already fixes by your early 20’s)!!   Well, I wasn’t too keen on the whole braces idea.  Seemed pretty fabricated to me.  Seemed like they just wanted to do braces, cuz that is just what they do. Their reasoning didn’t seem to hold up to well, but I was still willing to consider it, if another dentist made the same recommendations.  Then, just when I was getting ready to go, they said-Wait, Hold on!

OH, Yes, they had MORE!  They had a 5 page written contract, which showed a treatment plan for the angled tooth as consisting of wearing braces for 2 yrs, even if oral surgery was indicated after the 1st 6 months.  And that wasn’t all.  Oh, no.  They had a financial contract too, where I would pay them $5000 cash money at $500 a week!  I said, don’t you have my daughter’s insurance plan information?  Because she is on the state Medicaid program, and all routine services of any kind are covered, as are specialists, labs, tests, etc.  And, even non-routine services are covered if they are medically necessary (like an oral surgeon, to fix an angled tooth).  She didn’t even look it up, or make a call to the insurance.  She didn’t even bat an eye.  She instantly said, “oh, no, you are wrong.  Medicaid never pays for dental work.”  I fired right back and said no matter what my daughter has ever needed, the insurance has always paid and this should be no exception.  Unless of course, the insurance calls braces for what they really are, cosmetic and unnecessary.  In which case, she doesn’t need the braces, (just like I already said) and should go directly to a surgeon.  “oh no,” she said again, ” you don’t understand your insurance at all.  NO DENTAL WORK  is covered, except routine services.  So, I got up and walked right out with my daughter.  She thought I was over reacting.  And sure, my voice got pretty stern and unyielding, but can you really blame me? I mean, here I go to get a problem fixed, and they aren’t even interested in that.  All they wanted to do was get 5k from me and not even bother making the proper referral or treatment plan.  So, we got home and I immediately called the health plan.  The lovely lady that answered was so helpful, especially when she told me that I was exactly right about the insurance and how it worked.  She even said that if the tooth was the way I described it, braces would never have helped (and that is why they don’t ever cover braces, she added) and they should have immediately given us the name of an oral surgeon, knowing they couldn’t do anything to help this tooth.  What’s more, they never should have tried to sit there and sell me on braces when all of us knew they weren’t indicated.  And they flat out lied when they said oral services are never covered and this was my only choice for now.

So, finally, after getting such a wonderful affirmation from the insurance plan, I am reassured that I really did know how the insurance worked, and I really did know what services should have been indicated, and I really did know when I was being flim-flammed.   I am only glad I will never have to see those people again.  I wish I could make pariahs out them and get them run out of town on the next train, lol!  Charlatans and snake-oil salesman is what they are, yessir!  And, the best part is, we can fix my daughter’s tooth in one visit, AND it WILL be covered by the insurance.  The insurance will have to get a prior authorization, because this is not routine, but the rep assured us that if the xrays and doctors reasoning were anything like what I said, then it was a shoo-in for approval.

But the point of all this is, just because you’re paranoid that people are out to get you, by taking advantage of you at every turn (y’know, like by trying to sell you 5k of non-insured, unnecessary dental work), this DOES NOT mean that they aren’t really and truly out to get you, as these lovely dentists were certainly trying to do today.  So beware and remind yourself, just cuz you think you might be thinking a little crazy about being taken for a ride, you might still also be correct!