TMJ treatment VA The Case of More on the Insurance Two Step flickr cc credit hjl

It was a dark and stormy night….don’t you just love it when the story starts that way? Well, with most of the calls that I overhear to an insurance company, this seems to be appropriate. It was a couple weeks ago and I was overhearing one of my team talk to the representative from an insurance company. I will not mention the name of the insurance company since it does not really matter- most of them have the same level of ethics and caring as most hardened criminals. The difference is that this time they did it in writing. The policy states something like ‘We cover TMJ treatment’. The next line, however, states ‘We do not cover non-surgical treatment’ and the next line states ‘We do not cover surgical treatment’. So, in my little mind, the hamster is spinning on his little wheel as I get my head around all this. The little guy is running furiously trying to keep up with what my brain is trying to process. And after a moment I realize that this is more insurance doublespeak! I know I have written a little about this before and I just cannot let this one go for some reason! Was it some MBA who wrote the first line and then decided, “Hmm…these patients are a bunch of idiots…they never read the policy…let’s say we cover the treatment so we can truly say that to our idiot patients…then let’s just negate what we said in the next two lines”. My dear readers- all I can say is that this is brilliant, absolutely and totally brilliant! This MBA guy must think everyone out there in medical and dental world are a bunch of flippin’ idiots! Maybe he is right!

Just imagine if your automobile policy states that they cover you in an accident. Then the next lines state that they do not cover if YOU caused the accident, and the next line says they do not cover you if YOU DID NOT cause the accident. So now, in their advertisements, they can state that they cover you in the event of an accident because it says that in their policy manual. It’s like most deceptive advertising practices – just pick out what you want that suits your purpose and who cares about the rest of the sentences that tell the rest of the picture. I think it’s like those lawyer shows on TV when the lawyer asks a question and the person on the stand starts to tell the story, and the slick lawyer cuts them off and does not allow them to finish the whole story – the lawyer will just use the words they want and the heck with the rest of the truth. It’s deceptive and just downright dishonest and unethical.

So sorry for the deviation to the story, here we go, back to it. Anyway – the lady in my office was in disbelief when she read the policy back to the rep on the phone. She said this is a bunch of doublespeak and you could get in a lot of trouble for this. Eventually, after a short eternity of being bounced from one rep to another, to another, to another, did I say to another? She eventually reached a supervisor after many different transfers. She explained to the supervisor that she had the language in hand and would really enjoy filing with the state insurance commission and explain to them her concerns. Well, lo and behold and maybe even a hallelujah being sung in the background (I’m thinking about Shrek right now), the supervisor gave us approval and agreed to pay for the treatment that was needed! It sounded more like the supervisor was trying to pay off the upset patient more than anything else. As for myself, I just fell apart laughing when I heard that the case was approved, but it took multiple hours and countless transfers to get there. So I am thinking that if this is the level of difficulty it takes to get a case approved, why do we have insurance companies anyway? If you have to fight like a badger to help a patient get their claim approved, where does it all end? Perhaps we could go back to Roman times, have our disputes settled with my team members being gladiators and going against the reps at the insurance companies- let’s see them duke it out, maybe a fight to the death and winner keeps the money?

This is why folks, when you deal with those sons of…excuse me, super nice people, at the insurance company, that you write down their name (even if they won’t give you their real name), and write down the case number so that you can track the conversation. This way, later on when they say they never heard from you, you can refer them to the case number. Then when they say the case number does not exist, then you know for sure the game they are playing. This, my dear readers, is another example of the insurance company two step- a dirty little game they all enjoy playing and it costs you and it costs me dearly!