Thursday, January 7, 2010

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….

11 comments:

  1. Such an unbelievable wrong. Surely the surgeon's office can get a different response.
    Hope it all works out and is just a mistake. Fingers are crossed Quieten!

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  2. Quieten, the same thing happened to me, only the infection in my jaw began during chemo. My body was fighting cancer and trying to adjust to chemo not to mention how my womanhood was being challenged....anyway I had to have my upper teeth pulled and they were replaced by a denture and I didn't have to pay a penny. Is this an Ontario thing as I am in Alberta and once the doctor said I had to have this done there wasn't a quetion asked except from me who didn't want them to pull my teeth....I did though and all went well once I accepted yet another set back......I can't imagine anyone but his doctors can make this decision and then the insurance company doing what the doctor thought best. I was even covered for home care twice a week and a nurse came in daily to flush my lines and check my blood and vitals. Honestly not only didn't I pay any money from my own pocket but I was being paid 80% wages while I was away from work for a year.....Do you think this is provincial and not Federal. I hope all works out, it just doesn't feel fair to me that you have to battle with these people with all the other things you have to do, Good Luck with this situation.....always in my heart and prayers my friend.......:-) Hugs

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  3. Absolutely unbelievable! I truly hope that you find someone who can help you...or someone with a little common sense! Good luck.

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  4. Hi Quieten,
    That is so frustrating! Do you have any kind of dental insurance because I know that some dental insurance does pay for dental surgery. I hope things work out for you. Good Luck.

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  5. Hi Choices,
    Unfortunately we have no dental insurance at all. that is one of the things we lost when George retired.
    Quieten

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  6. Eternally Distracted,
    I'm not giving up but I really doubt I;m going to find an insurance company with common sense :-)
    Welcome to my blog - glad to meet you.
    Huggz,
    Quieten

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  7. Wanda- keep those fingers crossed for me - whew- this insurance stuff is a full-time job!!!
    Huggz,
    Quieten

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  8. Bernie - I keep trying to post to you but the blogger troll keeps kicking me off!!!
    I'm moving to Canada! When the Dr.'s came in and told us George needed this surgery first we didn;t even think about it not being covered. After all - it was surgery andwe have surgical coverage - Who Knew?!?!?!?!? There's a court case pending in one of the western states against an insurance company who did the same thing to someone else. Hopefully that petient will win and that will set a precedent for everyone else!
    Hope you day is going well and that you;re keeping warm and healthy!
    Love,Quieten

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  9. Hang in there, and definitely appeal the decision!!! I had to do the same on a number of occasions...so aggravating!!!! Again,George is very fortunate to have you as his advocate!!! You are doing a wonderful thing for him!!!! And he will never forget it!!! And I applaud and love you for it!!!! Sending you many hugs, and will pray that the Insurance will soon see reason!!! Janine XOXO

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  10. The insurance company's are totally ridiculous! Like the fact that they won't pay for my DIL's birth control but they will pay for a pregnancy.
    It just makes no sense to me. I will pray for you Quieten. Maybe they will appeal the decision.
    Love Di

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  11. I hsve you in my prayers, always!

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