The black hole of health insurance

I had a dentist’s appointment for a cleaning. While I was there, I asked about a spot at the top of one of my front teeth that was slightly discolored. I don’t think you’d have noticed it during normal social interaction, but I did, every time I brushed my teeth, or looked in the mirror with my lips pulled back, which I did in order to stare at the discolored spot.

I asked the dentist about the spot and he said, “I can fix that.”

He went on to explain that it was a spot that had decalcified and wasn’t medically problematical, although, if it got worse down the road, it could be. I didn’t need to do anything about it, but if I wanted to, no problem.

I’m not terribly vain, but it was one of my front teeth. I was tempted. But wait, I asked, isn’t that cosmetic? Insurance won’t pay for it, will they?

“Oh yes they will,” he said. “It’s all in the insurance code.” Then, with a wink, “It’s a filling.”

And there was my dilemma. I could have the spot fixed if I knowingly participated in a mini insurance scam. What else could I call it?

I’m astonished and appalled at how little we consumers know about how insurance works. One of our household saw a particular specialist every two weeks for months. Each time, we wrote a check for the thirty dollar co-pay. We never saw a statement from our insurance company about that doctor. When I asked the secretary how much an office visit was, she said it depended on a few factors, but ranged from $195 up. Really? There wasn’t a set office visit fee? How much was this costing the insurance company?

In that particular instance, we had no choice. We kept seeing that doctor until they resolved the problem. But invisible charges? I’m much less comfortable with that than I am with the idea that the dentist can code a procedure as a filling so I can have something fixed that I wouldn’t pay for otherwise.

Maybe the insurance industry is rigged to be one big, cosmic, balancing act; my conscience might keep me from taking advantage of my dentist’s offer because I’m angry that the real cost of our health care is hidden from us. If that’s the case, then in the end, I’m the one who loses.

I once called a doctor’s billing office when the paperwork from the insurance company listed several procedures I didn’t recognize. They said, “There aren’t really codes for what you had, so we picked the closest ones.”

Really? So not only does the insurance company not know the truth, but now I have no record of what was done to me because believe me, when they say they picked the “closest” codes, they mean they picked things that look totally unrelated.

I know I can’t change any of the bizarre machinations of the health insurance industry. I do, however, need to make a decision about that little, discolored spot. Would it be wrong to have it done? It is one of my front teeth…