If you've ever heard people complain about their insurance provider, either for medical or dental or vision, but never quite understood why that might be, then I'm here to provide you an explanation.
My wife recently had a crown made and installed into her mouth. We had to pay our estimated portion at the outset - a few hundred dollars. The insurance specified that it would cover 60% of the cost of the work ("major restorative" is covered at 60% while repair is 90% - the crown was to repair a tooth cracked by an old filling). We thought the price was rather absurd, but paid it because the alternative was not particularly appealing.
Last week, then, I received a bill from my dentist's office. I call today and inquired about the additional charge. The answer? Apparently there is a cheaper type of crown (gold) that could have been installed instead of the high-quality one my wife got (high-quality one will last longer, not to mention that it won't look ducky). The insurance company (MetLife) apparently has fine print in their coverage that they will only reimburse at the cheaper rate if such an alternative exists. Thus, though the crown was already order and installed, the insurance company has said after the fact "sorry, we'll only pay for the cheaper crown, you customer get to pay the difference."
The dentist's office went on to explain that they have this problem with fillings all the time, too. They use a non-toxic filling that blends with the tooth instead of a metal amalgam that may contain mercury, which is toxic and his been found to poison people with mercury gas over time. Nonetheless, because the amalgam filling is available, the insurance companies will only reimburse at that rate and the customer is, once again, left paying the difference.
This is a perfect example of what is wrong with the insurance industry today. I'm sure you have your own stories, too.
