Insurance

I got a $150 bill from my dentist in the mail and freaked out. See, I have dental insurance (from Great West), for free from my employer, so one day I figured that after 13 years since my last visit, maybe I should go to the dentist again. I had 2 cavities, needed a deep cleaning, and had some pockets they wanted to keep an eye on.

"Okay, fine, whatever. Take care of it" says I. -I was here to improve my dental health after all, the most obvious way to do that is to do what the doctor says.

So, I had the cavities filled and went back every 3 months for checkups like they suggested. Then I get this statement in the mail from my dental insurance company stating that they won't cover the entire cost of the resin fillings the dentist used to fill the cavities because they are in the back of my mouth and my checkup isn't covered at all because I'm only allowed a check up every 6 months.

Now, I wasn't given a choice about the material used to fill my cavities. I didn't even know a choice was available! How am I, as a customer, supposed to keep track of which teeth are considered "posterior" and therefore ineligable for resin fillings? I'd love to see a list of things that are or are not covered. How big of a book would that be? How much of it would I understand as a person who's not all that interested in dentistry. -Will I have my teeth for awhile longer? Good.

...And the worst thing is that this same exact thing happened with my Great West medical insurance in June. I had several bills that were denied or only partially covered and I ended up paying around $400 out of pocket. Needless to say, those little suprise bills hurt me that month -I have my money budgeted out pretty tightly.

Without the knowledge (or time) to figure out what's covered and what's not, a trip to the doctor or dentist is like a game of roulette with my money. Will this proceedure be covered? Who knows, spin the wheel, place your bets, and above all -Good Luck!

Ed's response to my rant -we should move to Canada. I'm totally for it at the moment.

Prescription Coverage

More problems with medical stuff. ..
I got an email Wednesday from our HR guy/Accounting Manager saying that :

In late December or early January you should have received notification from Great West that they were changing prescription plan carriers – from Advance PCS to Express Scripts. Following the notification you should have received a new prescription card – you will be required to present this each time to have a prescription filled. If you have NOT received a new prescription card, please call 800-663-8081, follow the prompts for prescription information and request a new card(s). Please know that your old card will no longer be accepted by your pharmacy.

Well, I was pretty sure I hadn't received this card, but I went home and looked for it on Friday. Nope, no card. So I called the number today and literally here's the phone tree I had to go through:

• Press 1 for English
• Press 1 if you are a Member
• Press 2 for Pharmacy questions
• Press 2 for Pharmacy benefits questions
• Wait while your call is being transfered
• Press 1 for English
• Press 3 for Benefits information
• Enter your Member ID followed by the # sign:
• Repeats Member ID
• Press 1 if this is correct
• Enter your birth date followed by the # sign:
• Press 1 if this is correct
• Wait while we process your request
• The last name associated with this Member ID is Steeve
• Press 1 if this is correct
• Press 1 for pharmacy benefits
• Press 2 for a different benefit type
• Press 0 to speak with patient care advocate

She tells me that I need to request a new pharmacy card through my insurance company. It's okay, though, she'll transfer me. To the phone tree at Great West!

• Press 1 for English
• Press 1 if you are a Member
• Press 2 for Pharmacy questions
• Press 2 for Pharmacy benefit questions

Then I finally get someone on the phone who can help me. She says she'll get the card out to me ASAP. How long is that? 7 to 10 business days. I'm out of my prescription as of this Wednesday! She says the pharmacy can call my insurance and verify my coverage. I'm sure that'll be fun.