June 22nd, 2013

Am I getting screwed here?

So, this is my first foray into having and using dental insurance. I have a DMO plan and have a dentist in the network. Posting this in Bad_Service for advice, but also because the dentist might be giving me bad service due to how she's charging me. Delete it if you think it's off topic, or I'll delete it later, or whatev.

I went in today to ask about getting a nightguard and asked how much it was going to be. She looked at my insurance papers, and said "Well, your insurance would cover 50%, but it would be really expensive. Instead, we charge you on a 'fee schedule.' It would be $450."

First off, that's $200 more than it cost me to get a nightguard in a state known for being extremely expensive, less than 3 years ago. I didn't have insurance then.

Second, if they WERE following what my insurance covers, then that would mean it costs $900 without insurance. I am EXTREMELY doubtful that a little bit of molded plastic costs that much.

She says that if I had a PPO, they'd be charging me almost nothing, because the PPO "actually pays us." However, the reason I got the DMO was because the coverage (so long as you went to an in-network dentist) was supposed to be way better, according to the papers (better coverage, lower deductible, and no max on benefits).

I already had her give me a tooth cleaning. It was $200 for a "deep cleaning." I used to pay $200 without insurance for the same cleaning, but it included the cost of X-rays too. This one did not. I was only supposed to pay 20% of the cost of the cleanings, according to my insurance. (I actually just checked my papers. Preventative maintenance, aka cleanings, is meant to be covered 100%. The next step is "basic maintenance", covered 80%, and then "major maintenance", covered 50%.) So this.. just sounds completely insane. (I didn't bring it up last time because, honestly, I'm new to insurance and thought maybe they didn't cover the "deep cleaning" or something.)
  • bang

Wal-Mart Pharmacy in Killeen, TX

This happened yesterday afternoon, but I wrote it out last night & I'm too lazy to re-write it :)

We went out to Wal-Mart in Killeen, TX to pick up my prescription. After returning some stuff, we went back to the pharmacy, which was slammed, and got in line. Despite there being seven other employees besides the pharmacist, it took over 10 minutes to get to the one woman manning the registers. I give my name, the cashier grabs my bag, scans it and gives me my total...

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In summation: After handling my prescription for five months, and three days after I call in my re-fill, Wal-Mart forgets to bill my insurance, then bills me my full co-pay for only four days' worth of medication, then tells me I need a new prescription for the remaining 26 days because their pharmacist arbitrarily decided to write "dispense 12 pills" on my prescription for 90 pills, they make me wait over two and a half hours to fix their mistakes, and THEN they give me four extra pills, fight with me and refuse to take the extra four pills back when I point out their mistake, and list a doctor I've never heard of in a state I don't live in as the person who prescribed the medication. MADNESS ENSUES.