The Bill

So it's 11:30 pm. Have to get up at 3:45 am to get ready and hit the road to KC. I can't sleep. Just laying there thinking about the shots, the food I can't eat, the pain in my jaw, the money. So thought I would add some more photos. I took some two days ago, but didn't have the courage to put them up. In fact, now I'm changing my mind again. I don't know what is worse, the shots in my jaw and gums or letting people see the real me.

Let me use this post to tell you about the costs. This list is what the finance gal at the hospital gave me last week. It's an "Estimate" and subject to change. Now let me say this first.....she initially told me that Insurance would not cover any of it because they are Out Of Network AND it would be considered a Pre-Existing Condition. However, the written estimate shows a portion that Insurance will cover.

This worries me. Did she get it in writing from my Insurance that it would be covered? Did she even really check with them? Or did she just look up the benefits and assume they will cover it? I don't have definite answers for any of this. So until I have something in writing from the Insurance Company, I'm assuming I'm responsible for all charges.

Here's the break down, word for word on the "Estimate" we signed.

NOTE: The amounts listed below are approximate amounts and subject to your Insurance payments. It has been determined that your Insurance is OUT OF NETWORK.

Extractions:

14 Teeth @ $273.00__________$3822.00
Less Insurance 60%__________$2294.00

Equals___________________$1528.00

Out of Network Deductible_____$750.00

Equals___________________$2278.00

*Requires $130.00 Down Payment each visit*
Will be billed under patient's Medical Insurance

Dentures:

Upper & Lower____________$3100.00
Less Insurance 50%_________$1550.00

Equals__________________$1550.00
Deductible_______________$50.00

Equals__________________$1600.00

**Dental Insurance has a $1500.00 yearly benefit maximum. Coverage will be paid UP to the maximum benefit. Patient's out of pocket amount may be higher than calculated.**

Surgical Obturator:
***Your Insurance Company requires a Letter of Medical Necessity AND a Medical Review before determining benefits. This could take 6 - 8 weeks to determine your benefit amount. Your Insurance Company will notify you and us when a decision has been made.


Now I have a few problems with this estimate, which I didn't catch or notice while we were there.

1. They are pulling 13 total teeth, not 14. There is one right next to my fistula that never penetrated my gums. It was decided they would not remove it as they feel it could damage my nasal cavity and cause my fistula to open wider.

2. The Obturator is noted on the sheet, but there is no cost listed at all. If my insurance denies my need for it, how much will I have to pay out of pocket for it? If my Insurance approves it, will it be covered under Medical or Dental benefits? Also if approved, what percent will Insurance cover?

3. Dr. Moore made a temporary plate for my upper gums. It's just for me to wear while my gums heal over the next 6 weeks. There is no mention of the temporary plate on this estimate. He stated that its nothing more than a surgical stint, to which he added 6 false teeth. The finance lady stated they could not claim it as just a surgical stint. Ok, then what is it? How much is it? Is it covered by Insurance? If so, what percentage of it will they cover?

4. She shows my extractions as being covered under Medical, rather than Dental. In our previous conversation, she stated it could only be considered Medical IF they sedated me. They are not sedating me. So how can it be covered under Medical now?

5. As I said above, how and when will I know for sure if Insurance will even cover anything? That Pre-Existing Condition clause scares the hell out of me.

So there you have it. Hopefully I can get answers to my questions in the morning. For now, I will try to get 3 hours of sleep in. Check back Friday evening for updates!