Going to a dentist is a stressful experience for most of us. However, trying to understand your dental insurance may stress you out even more, especially if your insurance is anything like mine. Here is a piece of paper that claims to "explain" the charges from my recent visit to a dentist to get a filling:
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I studied this piece of paper in detail for some time, and, after trudging past the quirky vocabulary, I remain puzzled:
Problem 1: What? Does $200 + $200 + $200 + $200 equal $400?
Problem 2: What is "Allowance"? What determines how much the insurance company will pay for a procedure?
Problem 3: How is "amount paid" determined? Why is the "allowed amount" on line 4 $60, but insurance company decides to pay only $16? How is line 4 different from line 2: same procedure, same charge and allowance, but insurance company made a different call on that. Why?
Problem 4: What are these codes in the "Remarks" section? Aaaah, there they are on the next page. At least an indication of what these codes are would be helpful. Or, you can go crazy and explain them away on this very page in the whitespace below the table!
The company's website, where I went to check what I am covered for, is also... wanting. Here is an example of what one sees when they go to check their coverage:
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Problem 1: What? Does $200 + $200 + $200 + $200 equal $400?
Problem 2: What is "Allowance"? What determines how much the insurance company will pay for a procedure?
Problem 3: How is "amount paid" determined? Why is the "allowed amount" on line 4 $60, but insurance company decides to pay only $16? How is line 4 different from line 2: same procedure, same charge and allowance, but insurance company made a different call on that. Why?
Problem 4: What are these codes in the "Remarks" section? Aaaah, there they are on the next page. At least an indication of what these codes are would be helpful. Or, you can go crazy and explain them away on this very page in the whitespace below the table!
The company's website, where I went to check what I am covered for, is also... wanting. Here is an example of what one sees when they go to check their coverage:
Looks reasonable, doesn't it? But hold on, let's check out the coverage details for the fillings:
Whoa, how do I navigate through this mess? Where are the fillings?
Problem 1: Is this a list? Is this free text? Are "Post removal" and "Enamel Microabrasion" the only two procedures (due to the visual cues - the dashes) or is every line a separate procedure?
Problem 2: Are the procedures ordered in any reasonable way, say, alphabetic, making it easier to navigate? How can one search for a specific procedure other than by reading the whole list?
Problem 3: What are these codes in parentheses? I guess these are procedure codes, but how do I know if my dentist is about to install D2391 and not D2394 into my mouth? And since there are codes for everything, why isn't there a code for the "comparable amalgam filling"?
Problem 4: Why wouldn't the text span the whole line?..
I think you get the point: either I'm a high school dropout, or this is really hard to read for a common person. A couple of gentle touches will make the "EOB" better, same goes for coverage - just adding some organization to the text improves its readability dramatically:
(the sad truth is nothing is covered).
After trying to understand my dental benefits and trying to read the "explanation" of such, I can only agree with our president: yes, we need a reform in health care. But this reform has to start at the very beginning, with people being able to understand their insurance. Improving the communication and readability of the benefits and coverage is the easiest step to make and, possibly, one of the most important.
