WE CAN'T MAKE THIS STUFF UP FOLKS!!
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….
. If that statement doesn’t scare you…this
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.
“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.”
“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
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
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.
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
those of you who would like to know:
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.
recommendation to everyone: read your
insurance plan brochures carefully YOURSELF
to confirm what a representative
tells you over the phone. Better yet.....CONTACT US
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.
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