TF (tortillafactory) wrote in bad_service,

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Aspen Dental (or maybe Excelleus BCBS? Or both?)

Last October, I went to the Aspen Dental office in Dewitt, NY for a checkup. It was my first in about three years, so I knew things weren't going to be great, but I had a perfectly nice experience up until it was time to talk money.

They said I needed seven cavities filled and three root canals with crowns.
Due to my insurance company's (admittedly pitiful) yearly limit of $1000 per person per year, I'd have to pay for most of this out of pocket - to the tune of about $7,000. Yeah, no. Might as well have been $7 million. I figured they were probably overpriced (they are), so I decided I'd get a second opinion and take it slow, maybe come back to Aspen if it made sense to do so.

They charged me $33 for the exam. I thought it was a little odd, since my insurance booklet said I had full coverage for all dental procedures, but I was tired and upset about the news so I didn't protest. I used my flex account debit card to pay.

(In case anyone doesn't know - in the U.S., money you spend on certain qualifying medical expenses can be deducted on your taxes. That is to say, you don't have to pay taxes on any income that you spend on doctors and crap. But this requires that people itemize deductions on their tax returns, which most people don't, because it's a giant pain in the ass and/or expensive to hire someone to do it for you. However, some workplaces offer you an alternative. You can elect to have some of your paycheck deposited into a fund called a Flex Spending Account, which will not be taxed. You can then use this money for all qualifying medical expenses - doctors, prescriptions, dentists, bandaids, condoms, the list goes on and on - either by submitting a claim to the people administrating the account, or by using a debit card that is connected to the fund. Often, those administrating the plan require the employee to send in receipts proving that the expenses they're using their debit card for are, in fact, legitimate medical expenses.)

I was a little surprised when the flex people wanted to see a receipt from Aspen Dental, considering they could clearly see that the charges were from a dental office. (What the fuck am I going to buy there, candy bars?) But I sent in the receipt that Aspen Dental had given me, which apparently wasn't good enough because it didn't itemize exactly what the $33 was for. I waited for my insurance company to send my Explanation of Benefits (EOB) - basically a piece of paper that explains what was billed at the visit and how much they paid, how much I paid, etc. Except for one problem - my EOB showed that I had paid $0. Not $33.

Several hours of phone-tag ensued. My local Aspen office insisted, snippily, that I had been billed correctly. They explained that since I had an "indemnity" plan, I was responsible for the $33, the portion of the claim that was unpaid after it came back from Excellus. Excellus said this was not correct - I was not indemnity, I was PPO. This meant I should have full coverage. The claim was paid in full, according to their records. And so on and so forth. I went back and forth between them, but was not able to successfully get them to communicate with each other. To their credit, the reps at Excellus were very nice and offered to call Aspen (they claimed no one answered). The woman I spoke to at Aspen, on the other hand, talked to me as if I was stupid and/or trying to scam them. She offered absolutely no solutions whatsoever, just kept repeating the same information back to me like a broken record. Due to the weirdness of dealing with flex account debit cards, I tried to get some general information from her about how refunds were typically issued. She flat-out refused to answer these questions, repeating instead that I was not entitled to a refund because I had been billed correctly. When I started to become a little agitated, she offered to have an office manager call me to explain things in more detail. Shockingly enough, the call never came.

Finally, resolution...I thought. A few days later, an Excellus rep called me back and told me she'd finally gotten ahold of Aspen. Things were cleared up, they had corrected my entry in the system, and I'd be getting a refund in a few weeks. Yay!

A few months passed.

I stopped by the office today to pick up my x-rays, so I can go somewhere that doesn't utterly suck. (And they charged me $5 to make a copy of them. Bastards.) There, I spoke to someone who informed me that I was still in the system as an indemnity patient and that I had been billed correctly blah blah blah herp de derp. Same old story, same old song and dance. She handed me a printout that showed where the $33 came from - it was, as I'd been told, the unpaid portion of the claim after Excellus paid their share. Hoping this would be helpful, I got back on the horn with Excellus when I got home. But no! The $33 wasn't my responsibility, it was the portion of the claim that Aspen had to eat because of the agreement they'd made with Excellus. (I don't know a lot about how this works, but basically, insurance companies often negotiate lower costs for procedures with medical providers. So, while an ininsured person might pay $200 for something, Excellus and the provider have negotiated a rate of $180 for someone who has certain plans through Excellus. Even if a patient's plan doesn't cover all or any of the procedure, they only have to pay $180 and the provider eats the $20 difference.)

The rep from Excellus that I spoke to today happened to be someone I'd dealt with before. She said she remembered calling them and explaining the situation, having them acknowledge that they'd updated me in the system, and telling her I'd get a refund. She called them again today, and got the same routine. Something tells me I shouldn't hold my breath for that check in the mail.

I honestly don't know where to go from here. I'm dizzy from going around and around in circles with these ridiculous people. I don't know who's lying and who's telling the truth, and the fact that no one will acknowledge wrongdoing is starting to wear away at me. Who should I be talking to? What can I say? I'm thinking of stopping by the office again tomorrow, and I want to be fully prepared before I do so. Am I within my rights to ask the office manager to call my insurance company while I'm sitting there? What else can I do to get this thing resolved already?
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