WE CAN'T MAKE THIS STUFF UP FOLKS!!  


At BDA, we strive to be "on top" of everything.  That includes learning about changes in dental plans and researching new options for helping patients afford their care.  How much faith do you put into your dental plan and the representatives who are supposed to understand and explain your policy to you? 

To prepare for a patients upcoming visit, I contacted their insurance company to get a better understanding of their coverage. To my surprise, the company representatives were ABSOLUTELY CLUELESS about the plan they sponsor for a large corporation of thousands of employees.  Yes…. thousands.  If that statement doesn’t scare you…this will.    I managed to speak with three representatives who all told me three different answers to each of my same questions.  My heart almost stopped when one representative explained her understanding of a “Missing Tooth Clause”.  

Again…..we can’t make this stuff up.       
        
The representative: “Yes, this plan has a “Missing Tooth Clause”.  So, that means if the doctor decides to work on the tooth that is missing, he can, but we will not pay for that service….but he can still work on that missing tooth.  The patient will be responsible for the charges.”  

My response:  “I’m sorry….what? (as a small chuckle slipped out) Are you serious?  That’s your understanding of a Missing Tooth Clause?  Oh my….Ok.  Is there someone else available who has a better understanding of this plan…and what a “Missing Tooth Clause” is…. a supervisor perhaps?”  

She attempted to transfer me to a supervisor, but I ended up being transferred to another call center representative who informed this particular plan in question did NOT have a “Missing Tooth Clause”.  I explained the first representative’s answer and explanation.  This particular person’s response was…..silence.  I immediately requested a supervisor….again.  

I was successfully transferred to a supervisor who somehow believes the initial representative’s explanation was satisfactory, and couldn’t explain the second ones uncertainty and silence.  When I gave her the proper meaning of a “Missing Tooth Clause”, she merely stated they are not quite familiar with all of the details of the plan yet and are still in need of training.  I was dumbfounded.   

The sad part, is the term “Missing Tooth Clause” is NOT new.  Folks, these are representatives who speak with members and providers everyday about the plans they manage, who are clueless to the basic definitions in your dental plans. Frightening eh?  

For those of you who would like to know:   If your insurance has a Missing Tooth Clause, this means you have to have had a tooth extracted while covered under the current plan in order for it to be replaced with an implant, bridge or partial denture.  If the tooth was missing before you were covered under your current plan, a Missing Tooth Clause will prevent your current insurance from covering the cost to replace that tooth.   

My recommendation to everyone:  read your insurance plan brochures carefully YOURSELF to confirm what a representative tells you over the phone.  Better yet.....CONTACT US!    
    
For questions, contact us at (703) 931-5555, or visit us online at www.ballstondentalarts.com.  Follow and friend us at www.facebook.com/ballstondentalarts.va/ where we have new and useful information almost daily.