Approximately 6 weeks ago, our insurance company denied J's orthodontic work. She needs braces to move a tooth out of the way, because it blocking another tooth, which is, apparently, rotting in her gums right this very minute. Because it should have come down EIGHTEEN MONTHS ago, but did not, due to the other, blocking tooth. Because the braces are medically necessary, the orthodontist felt that insurance would cover it as a medical treatment, rather than an (uncovered) orthodontic one.

As I complained about 6 weeks ago, the claim was denied. The reason being that the administrator at the dentist's office somehow submitted the claim under E's name. Which was dumb. Because E's never been there.

I left angry voice mail messages, and after the weekend received a call saying that they'd resubmitted the paperwork under the proper child's name. There was little else to be done at that point, b/c J was 1/2 out the door to X's house in the Middle of the Country. I assumed this meant that things would get approved (or not, but at least on the substance of the claim, and not because of administrative ineptitude) while she was gone, and we could get it taken care of upon her arrival back home.

Today, I went and picked up our mail from the post office that had been held during our trip to Europe.

Guess what was in it?

A denial. From the insurance company.

Guess why?

Administrative ineptitude. Not under E's name this time - just some other fuck up with the paperwork.

I didn't get as angry as last time.

I also just don't know what to do. This cannot be something that I have to just accept. We first went to the dentist in February to get this issue taken care of. The x-rays showed a clear problem. This is not a cosmetic issue. This is a question of her tooth being trapped in the gum, and potentially breaking down. An adult tooth. Her fucking FRONT tooth. The orthodontist and the dentist both were struck by the unusual nature of the problem, and both talked about how we would take care of it "right away" - but b/c of administrative and insurance screw ups, it's 6 months later, and we don't even have an appointment set up.

I have made phone calls attempting to go up the chain both with the administrative department, and with the orthodontist himself. I am going to see if contacting the orthodontist directly (which I would have done in June, if J wasn't on her way out of town for 5 weeks) will work get a fire lit under the admin people faster. OR - if I can work out an alternative payment plan.

I'll pay for the braces myself. I don't care. I need it taken care of. But without talking directly to the orthodontist, the office won't let me do that. They say it needs to run its course. The course they keep fucking with.

My other option is to just go to another dentist, and that's very appealing. Since this one has so royally screwed up twice.

But there are insurance issues. I have new insurance as of 9/24, and I'm afraid to switch this close to the insurance change over. If I go to another dentist, planning to just pay out of pocket, will my new insurance cover it once the change over happens? Or will it be a 'pre-existing condition' that won't be grandfathered in?

I also am worried, b/c it's likely that she'll need surgery. I can't pay for surgery out of pocket. Braces I can, and most people do. But not surgery. If I go to a new dentist, and it turns out that surgery is now immediately necessary, I can't do it - and if it's seen as a pre-existing condition once new insurance starts up - then maybe it won't ever be covered?

This is why, despite my anger and their ineptitude, I am trying to force the issue with the current dentist, where the x-rays and the chart and the file and the info already exists. I want to make this happen sooner, rather than later. If she needs braces, and possibly surgery, I'd rather it happen before I start work in 6 weeks. If I have to start anew with a new provider, then it won't happen.

Woe is me. Woe is J. Woe is us.

Labels: *J*, anger, dentists

posted by Zuska @ 4:57 PM 2 comments

Friday, June 22, 2007

The Fire Within

When I get angry, really angry, I get a little ball of fire in my chest, and it makes me want to lash out, physically. Never at a person. I don't want to HIT people. But once, I hit the wall with a belt. Another time, I threw a banana. SEVERAL times, I threw phones. I've broken many phones, actually.

I think the last time I remember throwing a phone, I was in CA, and a single mom, and living paycheck to paycheck. I had just gotten paid, and therefore had plenty of money to go grocery shopping, pay my bills, etc. Yet, when I went to the grocery store, my card was declined. I called the bank to find out what was going on, and they told me that they randomly selected my check for a hold. A 2 week hold. On a PAYROLL check. They said, "oops, sorry, didn't know it was a payroll check, but the hold's on it now, so, too bad." (I'm pretty sure it's illegal to put a hold on a payroll check. It was in CT, I know that.)

I was so angry, I threw the phone from one corner of a relatively large room into the TOP edge of the wall on the opposite corner. HARD.

I mean, come on. I had to buy fucking GROCERIES.

And no, I didn't have credit cards. I had canceled them ALL after post-divorce necessities (i.e., rent and full time childcare before I found a full time job) ran them up toward $30K, and I only was able to pay them off b/c an uncle died. I was done living above my means.

That's the last time I threw a phone.

Today, I almost did it again.

I held it tight, with my knuckles white, and I said 'FUCKFUCKFUCKFUCK!' a thousand times.

I didn't throw. I held it tight. And I took deep breaths.

And I opened up my Contracts notes.

And I said "fuckfuckfuckfuck"

Then I called:

Hello, Insurance Company. This is Zuska. I just received the notice that you've denied the claim for my daughter's orthodontic work, which was thought necessary by her dentist and orthodontist as a medical procedure because her front tooth is trapped in her fucking gums [no, wait, i didn't say fucking], and so we applied for approval for dental insurance to cover the procedures required. This claim was denied. The problem is, the claim that was denied is in the name of my other daughter WHO HAS NEVER BEEN TO THIS FUCKING DENTIST IN HER ENTIRE LIFE. [no, wait, I was still calm].

Insurance company lady clucked sympathetically at me, and said:

oh yes, you are right, that would explain why we had no x-rays and no medical records and no doctor reports and no ANYTHING on file for her, and so that IS in fact, why it was denied. I'm sorry. The only thing you can do is have your dentist resubmit the claim. And, no, we can't expedite it, it wasn't our fault, it was the dentist's fault.

BUT IT HAS BEEN 10 FUCKING WEEKS, HER TEETH ARE GETTING WORSE, I HATE YOU!

No, I didn't say that. I pushed the "talk" button and again wandered from room to room saying fuckfuckfuckfuckfuck.

J hates her teeth. She is sad about the state of her teeth on a daily basis. There is of course the constant hope that since she is only 9, her teeth will get better on their own, but you see, they aren't getting better. They're getting worse. She's this gorgeous amazing kid who has to feel like she's NOT gorgeous or amazing, b/c she spends all her time trying to hide her fucking TEETH from the world. First she had a surgery to get an "extra" tooth removed, and the dentist in her Father's state felt that once that was removed, everything else would slide into place. But they did not. So I took her to the dentist, and we started this in February, what with the x-rays and the follow ups and the other baby teeth being pulled and the this and the that ....

(see? beautiful and amazing and gorgeous)

we were told 4 weeks.

It's been 10.

And I wanted her to have her braces ON before she left for the summer, so the braces could start to work (hopefully moving the blocking tooth to its rightful place so the blocked tooth can come down - also hopefully correcting her overbite, even a little, since that's not the goal of these braces - that will be left to the later braces, when she's in 7th grade, or something), and if it turned out that she needs another surgery (to put braces on the stuck tooth in order to pull it down into the land of sunshine), it could happen before she starts school.

But now that's impossible.

I called the dentist's office all afternoon. I called the right department about 100 times and left messages, but they didn't call me back. I think that the administrative offices are already in the summer "Fridays off" mode that takes over in Boston. Then I called the wrong departments, and told them that I was wondering if they were closed, since no one was answering their fucking telephones. They said "no, what do you mean?" They gave me another number, and so I left 15 more messages.

I am trying to come to terms with the timing of everything. Since we only got our answer today, on June 22, the chances of her getting all the prep for braces done AND the braces put on before she leaves on 7/6 are pretty slim. So even if today's letter said yes ... it wouldn't have happened before she leaves for 4 weeks. Hopefully I'll be able to fight and argue and bitch and moan while she's gone, and get the dentists office to at least expedite as much as they can, and hopefully have approval in hand before she gets home.

I am so mad at this dentist's office, which is one the few covered by current insurance, that I 1/2 just want to stop. We're going to be on ridiculously fantastic insurance come the fall with my new job (as opposed to the current shitty insurance), and I will likely switch providers then. But I don't know if she can wait - I was told by at least one person that there's a risk that if her tooth stays in the gum, it will start to break down. It needs to come out and play.

I am not a happy momma.

Labels: *J*, anger, dentists, insurance, stress

posted by Zuska @ 4:47 PM 2 comments

Friday, April 06, 2007

Teeth

Obviously, sequestering myself in my room so the kids can all play "American Idol" without interference results in multiple blog posts. There are 4 girls: They each take turns singing (they're all involved in a theater thing that requires them to sing on stage, so they're more than comfortable with this) while the other three rip them to shreds, saying they're "too young" or that they were "off pitch" or other various things they've heard on Idol during audition week. Right now, J's doing a really pathetic attempt at "beat boxing." He he.

_____________________________________

Three out of four of us in the house are having various levels of tooth issues.

J had two appointments this week. Monday the filling which had to be done so we could go on Thursday to get pictures and x-rays taken so that we could apply to the insurance company for orthodontic work to be classified as "dental" so that it would be covered (chances are HIGH). We thought they were making a mold of her upper mouth, and she was dreading that, but they didn't. They said that's the first step once we get approval, which may take a month. Damn. But all they did was take pictures and x-rays, and it was quick, and she was pleased to have minimal discomfort.

I bought Crest Whitestrips yesterday. [yes, that's it.]

Beloved is at the dentist right now. He sent me a text message to say they're pulling his tooth. Yikes. I guess he wins the "most serious dental procedure" award for the month. I told him if he's really brave and doesn't cry, he can have ice cream tonight.

I'm not sure appreciated receiving that text message while sitting in the chair ....

Labels: dentists

posted by Zuska @ 11:08 AM 0 comments

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