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Jan
19
2006
In yesterday’s mail, I got a form from my dental insurance plan from the State of Illinois telling me that the gold onlay I just had replaced was not covered. So, I thought the first thing to do was to get online and see what the list of benefits are. I went through the procedure of trying to register as a new user, since I had not been at their web site before, but to no avail. The system would not take my SS# or the ID# printed on my membership card. However, in a manual from the state, I did find a web address that shows all the dental benefits with their codes. What my dentist had coded her work was not on the list, but from what I could see (and what I thought I understood), it looked as if the procedure was covered.
So, this morning I called the benefits hotline. After the usual waiting period, a woman came onto the phone. I asked her about why my procedure was not covered since I thought that what had been done seemed covered. I told her what I had seen, that it said a crown full cast in noble metal was a covered benefit. She would not discuss this with me if I did not have the code of what I saw and would not give me the code. Luckily, my web browser still had the address I had accessed last night and I went to the benefits page and gave her the code. I also mentioned my problem with their web site and was told that lots of people had been calling in to complain.
I asked her why what I had done was not covered. She said that only porcelain was covered. I said what about the line on the benefits page that talks about crowns made of noble metal. What, I asked, is noble metal? I was told it was a certain type of metal. What kind? Would gold qualify? It’s a certain type of metal. (Who’s on first?) I said that all I wanted was a definition. She said to call the Center of Management Services (the state’s contracting agency for all benefits). I said that it would seem that my dental insurance carrier would know definitions. And, throughout our entire conversation from the first question of my name and SS#, it seemed to me that this woman was surly, argumentative. I remained calm but switched from a friendly tone to just deadly calm.
I asked to speak to supervisor. She said okay but then tried to deflect me by telling me again to call CMS. I asked again for a supervisor. She acquiesced and promptly lost me in the transfer…..the phone went dead.
So, I called my dentist’s office and asked the same questions I had asked of my carrier. I got clear and concise answers. Seems like inlays and onlays are different than a crown. Seems like a crown has to cover all surfaces of a tooth and go down into the gum. Insofar as noble metal, that definition is still waiting to be answered.
After my morning chores, I called the hotline again and asked for a supervisor. As luck would have it, the same woman I had talked to before was on the line. She asked if it was in relation to a crown, so it was clear it was her. This time I got a supervisor and explained the entire thing to her (including the attitude of the person who I had dealt with earlier). While she gave me a working definition of a crown (covered) versus an inlay or onlay (not covered), she had no clue what noble metal is. But mine was tested.
So, this morning I called the benefits hotline. After the usual waiting period, a woman came onto the phone. I asked her about why my procedure was not covered since I thought that what had been done seemed covered. I told her what I had seen, that it said a crown full cast in noble metal was a covered benefit. She would not discuss this with me if I did not have the code of what I saw and would not give me the code. Luckily, my web browser still had the address I had accessed last night and I went to the benefits page and gave her the code. I also mentioned my problem with their web site and was told that lots of people had been calling in to complain.
I asked her why what I had done was not covered. She said that only porcelain was covered. I said what about the line on the benefits page that talks about crowns made of noble metal. What, I asked, is noble metal? I was told it was a certain type of metal. What kind? Would gold qualify? It’s a certain type of metal. (Who’s on first?) I said that all I wanted was a definition. She said to call the Center of Management Services (the state’s contracting agency for all benefits). I said that it would seem that my dental insurance carrier would know definitions. And, throughout our entire conversation from the first question of my name and SS#, it seemed to me that this woman was surly, argumentative. I remained calm but switched from a friendly tone to just deadly calm.
I asked to speak to supervisor. She said okay but then tried to deflect me by telling me again to call CMS. I asked again for a supervisor. She acquiesced and promptly lost me in the transfer…..the phone went dead.
So, I called my dentist’s office and asked the same questions I had asked of my carrier. I got clear and concise answers. Seems like inlays and onlays are different than a crown. Seems like a crown has to cover all surfaces of a tooth and go down into the gum. Insofar as noble metal, that definition is still waiting to be answered.
After my morning chores, I called the hotline again and asked for a supervisor. As luck would have it, the same woman I had talked to before was on the line. She asked if it was in relation to a crown, so it was clear it was her. This time I got a supervisor and explained the entire thing to her (including the attitude of the person who I had dealt with earlier). While she gave me a working definition of a crown (covered) versus an inlay or onlay (not covered), she had no clue what noble metal is. But mine was tested.
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