Here’s a bit of the healthcare system at its best!
George had to have all of his teeth surgically removed the day before the laryengectomy due to a jaw infection. Without this surgery the laryngectomy could not be performed and George’s life could not have been saved.
We have now been informed that the insurance company will not pay for the dental surgery. They do not cover dental procedures as they are considered cosmetic in nature.
I spent most of the day on the phone explaining to various customer service representatives, supervisors and a clinical care insurance supervisor (whatever that is) that his dental surgery was a medical necessity not a cosmetic desire.
Not only do they not want to cover the surgery but they will not pay for any kind of dentures, implants, etc. The one customer service rep told me the insurance company does not consider teeth to be a necessity! So -- here I am, on the phone, jaw now on the floor, trying to speak in complete sentences and wanting to put my hand through the phone and shake the life out of this woman; all the time trying to digest the reality that teeth are now a cosmetic frivolity not a quality of life necessity or a physical need.
This young woman then proceeds to tell me that among the things they will cover is the prescription medication Viagra. That “it is a medical necessity because it provides a fuller quality of life to the patient taking it.” SHE ACTUALLY SAID THIS TO ME!!!!
I guess God just gave us teeth so we can look pretty when we smile!
I’ve spent most of the afternoon shaking my head. It’s starting to be funny – in a sad sort of way – but this makes no sense. Somewhere, in some office, far, far away from the reality of life, sits an insurance executive with a mouth full of teeth and no love life! :-)
I finally spoke to the surgeon’s office and they are going to assist me in appealing the decision. Keep your fingers crossed….