The insurance problem

I’ve received outstanding health care during the past six weeks.

I’ve also received an up-close look at what’s wrong with the health insurance industry in the United States.

If I had any doubts as to the status of that industry, my dentist erased them during my first visit, weeks ago, when he said he hates insurance companies.

This, from one of the best dentists in the area, one with more than three decades of experience.

It’s a shame that any medical provider would be forced to have such an adversarial relationship with people in an field with which he must work so closely. That is not how health care is supposed to function.

Red tape is a huge problem with the industry, and there is a gaping difference between the best possible care people should receive and the care they actually receive. For example: According to my dental insurance, treatment for a problem is covered only once in a three-year span. I lost six teeth in this attack. What is the best possible solution? Implants. But therein lies a problem — the implant process takes six or more months from beginning to end. In the meantime, there needs to be a temporary solution — in this case, dentures.

But my insurance company does not see it that way and will not cover both. For them, it’s a case of treating the same problem within too short a span. Once the problem is “solved,” insurance would like to wash its hands of it. Even if it would not result in the best possible care.

Thankfully, the dentists are working with me so that I get both treatments. But it’s been more a case of “let’s do our best and hope the insurance company will pay for implants” rather than “the insurance company wants the best care for you.”

When I was at the oral surgeon’s office on Thursday, I saw another example of the industry’s flaws.

After undergoing a jawbone graft, I stopped at the front desk to pay my co-pay and schedule my next visit. A woman walked up at the other side of the desk, and I happened to hear her conversation with a secretary. The woman had just had a tooth pulled. The secretary asked for payment.

The woman, her jaw swollen and clearly in pain from the extraction, contorted her face even more. She clearly wasn’t expecting to owe anything.

“I checked with my insurance company, and they said extractions are covered,” she replied, clutching her jaw.

The secretary explained that yes, the woman’s insurance company United Healthcare, *had* covered extractions … for just a few days. The coverage began Jan. 1. It ended Jan. 9.

It became evident what happened in the meantime: The woman was told she had extraction coverage starting Jan. 1, so she scheduled one. Then the coverage was dropped just days later. Should she have known about his abrupt change in coverage? Maybe. Should someone have checked with her beforehand to make sure she knew that the procedure would come out of her pocket? Definitely. Should United have been allowed to do what it did? No.

As life expectancy increases and technology improves, we will all rely more on the health care system in the coming years. And we need to demand more from the insurance companies who broker that care. After all, their job is to work with us, not against us.

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  1. Check, please | Jon's Story - May 13, 2016

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