I received a bill from my dentist for $66.49. The statement read that my Blue Cross dental plan would only pay for a temporary filling on my lower left molar once per lifetime.
Being a relatively small amount, I was tempted to pay. Instead I phoned the dentist's office and inquired. Are you sure that this isn't covered? Didn't you check with Blue Cross when you gave me my bill? They said that the check was only to establish that I had a plan, not to verify specific benefits.
After looking at my plan and not seeing this exclusion, I phoned Blue Cross. Yes, they had denied the payment, but it was for "Traumatic Pain Control". I agreed that this wasn't covered (and I hadn't received it), but the dentist's office had said that a temporary filling had been denied. Blue Cross said they would pay for the filling and thought the dentist's office had used the wrong code in their claim.
I called the dentist's office back and told them they had probably made a mistake in their claim. They said they had used the code that the dentist had written down on the chart, but that they would check again.
Result: the bill was cancelled.
Lesson: It always pays to inquire. Question: How often do medical and dental offices make mistakes in their billings? More alarming: If the practitioner writes down the wrong code, do we receive the wrong service?
The larger lesson to be learned here is that much bureaucratic authority is exercised simply because it is conceded. If you challenge bureaucratic decisions, you will frequently discover (1) that some error in interpretation has been made or, (2) very commonly, that the authority exercised has no regulatory or legal basis. I had a situation five or six years ago in which I was being completely hamstrung in my academic programme by edicts being issued by various administrators employed by my college. They backed up every decision by referring to the college's policy manual. When I checked the manual, however, I discovered it supported none of their decisions. These administrators were making up policy as they went along and referring to the manual to enforce their will, obviously banking on the assumption that no one would actually read it. In my case, unfortunately, every challenge simply contributed to an ever-ramifying network of equally spurious edicts. It was only resolved when I sent a lawyer in to have a chin-wag with the dean. It was smooth sailing from then on.
ReplyDeleteTrue. Many people won't challenge authority, possibly because they lack confidence or haven't been successful in the past. However, if they find out the rules, prepare their arguments carefully, and are willing to be persistent, they can frequently get arbitrary decisions changed.
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