In this article, I will give you an example of what can go wrong when you make a dental appointment and when you have HMO medical insurance.
I was in a dental office recently and watched this drama play out in front of my eyes. That is when I knew I had to write this article and add it to my Medicare and Other Health Insurances book.
This man had an appointment in this dental office. He was in pain. He checked in his list of Dentist’s that were contracted with his medical insurance. He called the Dentist and made an appointment.
What is wrong with this. Can you tell me?
Everything in medical or dental insurance works by contract. Yes, his medical insurance was contracted with this Dentist. But the man never called his insurance company and said, “I want his Dentist and I need an appointment immediately I am in pain.”
So, what happened? He didn’t make a contract with his medical insurance to plug him into this Dentist. He showed up and said, “I have an appointment and I’m in pain.”
The receptionist said, “I am sorry sir the Dentist can’t see you because you are not contracted with this office.”
“But you are on the list of dentists I was given that is on my plan”
“Sir, you did not call your insurance company and tell them you chose this Dentist and since you did it today the insurance company should have called us and we would have seen you.”
Whose fault was this mix-up?
It was both the Dental receptionist’s fault and the man’s. The receptionist should have called the insurance company when she didn’t see his name on the computer as being this Dentist’s patient.
The man should have realized how his insurance works.
In most cases, this is how we learn by doing.
Thank you for reading my article. Copyright Linda Meckler 2022