Getting Metlife Dental Coverage Is Like Pulling Teeth

Why are insurance forms and regulations written at the 27th grade level? We’re not sure if even Metlife knows. Reader Tim certainly doesn’t, all he knows is Metlife can’t figure out how to get his dang teeth replaced. Sadly, the three teeth wouldn’t need implants if it weren’t for the first dentist delaying in removing the first tooth.

No doubt he was still trying to figure out how the insurance coverage worked…

(Photo: imorgan73)


Tim writes:

Metlife supposedly has very high standards for the dentists they select for the clients -myself- to select from….. It seems these professionals would be well versed in Metlife’s payment protocols……

After one dentist delayed in removing one tooth, I lost another tooth and that being part of a bridge cause me to loose a third tooth. The company details of the dental plan state implants can be used for single tooth replacement or a lifetime total of four to hold a denture to replace all upper or lower teeth.

I quit that dentist -

The next dentist tried pushing a retainer with teeth attached on me after I had repeatedly told her no retainer with teeth – implants or nothing. She proceeded with getting the retainer and after shoving the “we can yank whatever and ruin whatever in your mouth waiver” I got irritated and she terminated the business relationship.
I contacted the credit card company – they removed the charges. I contacted Metlife and they were full of reasons why they cannot remove the charges. After several phone calls they removed most of the charges – but put one back on my account.

After that I found a decent dentist. He recommended a periodontist to provide the implants. The periodontist contacted Metlife for my insurance coverage and Metlife responded with a fax that shows coverage, but not the details – coverage for up to four implants, but not under any particular conditions. Now Metlife has come up with many versions of why they can refuse to pay – one says I should have gotten a pre-assessment, then next says a pre-assessment does not mean anything – it is subject to change, one says single tooth replacement means only one tooth, not replacing one tooth and then two more teeth.

I am not a dentist – I and the general public have to rely on the professionals to work with the insurance professionals. When an insurance company pulls this underhanded, vindictive behavior – there is something wrong!

An industry that needs streamlining if there ever was. It used to be that people lost teeth because of lack of dental care. Now they’re losing them because of it. — BEN POPKEN

Comments

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  1. MaliBoo Radley says:

    This guy is lucky he’s able to get dental coverage! However, even if he has it, it’ll most likely not cover the really important stuff. My mother is going to have to spend nearly $30,000 to get dentures, and her insurance isn’t putting up one thin dime. Since when is Dental not as vital as regular health care? The same goes for optical care. I need my glasses as much as I need antibiotics. Argh!

    My teeth hurt.

    http://www.kilgoreskitchen.blogspot.com

  2. mconfoy says:

    We have Metlife at IBM. They suck. Unless you are lucky enough to find a good dentist on their plan, you will pay, and pay, and pay.

  3. Sir Winston Thriller says:

    $30,000 for dentures??? That sounds excessive…http://www.bracesinfo.com/dentalcosts/ has a calculator for common dental costs, and the most expensive, a gold partial, doesn’t even hit $4,000.

  4. MaliBoo Radley says:

    They’re dental implants. They’re like dentures, but more permanent.

  5. MaliBoo Radley says:
  6. mconfoy says:

    Why is it like pulling teeth to find dental insurance that actually pays for things? Even if they pay at “MetgetaLife,” he will easily go over their $2500 maximum per year.

    And we now know about the kid in Prince George’s County, Maryland, that died of the tooth infection that spread to his brain as his mother had temporarily lost Medicaid. Read today’s New York Times on how the new requirements to proove you are a US citizen are driving citizens off of Medicaid, so expect to see more of this type of thing in the future. Its like living in a third world country sometimes.

  7. MaliBoo Radley says:

    The same is true in England. As far as I know, only people under the age of 18 are entitled to any kind of free dental care. The rest of us are screwed.

  8. kimsama says:

    How old is he?! Poor guy, losing teeth left and right. Losing teeth like that has got to be traumatic, not to mention the expense.

    One word of advice — brush and floss like they tell you to before it’s too late. And invest in a fluoride mouthwash and use it religiously. When I was a kid, my parents made me use it — no cavities. Then when I got older I decided not to listen to them — 2 cavities at my next dentist’s appointment. Went back to using it 2x/week — no cavities ever in the intervening decade. I probably wouldn’t need it, but sometimes I’m a lazy brusher/flosser and it covers my ass.

  9. mfergel says:

    I don’t know. I haven’t had any problems with metlife.

  10. Ass_Cobra says:

    I had a hell of an ordeal with United Healthcare’s Dental Coverage. Similar to the writer’s complaint I had to get a tooth extracted and a replacement. Fortunately I had a dentist that was more concerned about my dental health than booking a procedure he could do and he recommended me to a great periodontist.

    I had my visit and a treatment plan drawn up. I tried to have a pre-assessment done, but the insurer informed me that it would take at least six weeks to complete and it was only an assessment not a pre-authorization which would take even longer. The periodontist felt that it would be best to get the extraction taken care as soon as practical, since the root was in the process of reabsorption and the hairline crack between the crown and the root could give at any time, resulting in a much more costly and risky emergency extraction. Also there is a period of time (between 6 months and a year) that the area needs to heal and regenerate bone before an implant can go in so delaying the extraction delays the implant, etc. etc.

    So I get the extraction, it’s gnarly, I have pictures. It’s definitely more expensive than getting a tooth pulled as they actually had to cut the gum and they also do a bone graft to the jaw. I submit the claim for reimbursement and while all the procedure codes are covered at 80% it is covered at 80% of what the insurance company has determined to be “usual, customary and reasonable”. Apparently they think I live on the island of impoverished dentists. What I was billed nearly $800 for was covered as though it should have cost $150. I can assure you I was not being ripped off by the periodontist. He spent nearly 90 continuous minutes working on me and the bone graft materials were on the order of $250 themselves.

    I called them up repeatedly and they continued to point to their UCR chart and told me that was the best that I could do. Okay whatever, I’m shafted to the tune of $520 on this one. Older wiser, I submit a preassessment for the actual implant and request what their UCR will be for each procedure code. They refuse to give it to me. Seriously, they say it changes so much that it would be meaningless and that they will not “waste their time” dealing in hypotheticals. I gently explain that it ain’t a hypothetical. I’ve had my tooth extracted, I’m going to need it replaced and since I have to get by on my good looks, I’m getting an implant. They don’t budge, they won’t actually tell me if I submit my treatment plan what they will likely reimburse.

    I get the implant, submit the claim. Get an insultingly small amount. Bitch, moan, get stonewalled and give up. The best advice I can offer is to not rely on Dental insurance for any major dollars. Save the $45 a month, floss, get regular check-ups and try to avoid playing hockey without a mouthguard.

  11. MeOhMy says:

    I had MetLife Dental. Whether or not they would cover the claim, and how much was covered seemed to be determined on a “crapshoot” basis. And I’m talking about routine maintenance – cleanings and annual x-rays.

    The people at my dentists office told me flat out that of all the insurance companies they deal with, Metlife is easily the worst of the lot. And I believe it.

  12. formergr says:

    Ah yes, the old “usual, customary and reasonable” crap. My dental insurance pulls that all the time, and I have a sneaking suspicion that they calculate the usual and customary based on what dentists in rural, southern Illinois charge, not those in Chicago, where I get my work done.

    I just try to stay thankful that I make enough to cover the shortfall without going hungry, and that I have any dental insurance at all.

    Seriously, how do people on minimum wage afford a root canal? Oh, I guess they don’t…

  13. Gari N. Corp says:

    I’ve got to say, I was pretty impressed by Tim’s ability to characterise his dealings with the dentist as a business relationship. For me it was more like an abusive relationship. I’m was putty in the hands of my dentist, and only left him after I had to get an extraction as the result of his negligence.

    But yes, since I also just had root canal on another tooth that was about to implode, I’m also mystified as to how even those with insurance can cope with the cost.

    Probably best, as ever, to go to a good dentist little and often. And try that Fluoride hoo-haa, even if putting it in the water was the CIA’s idea.

  14. Ass_Cobra says:

    A correction to my above story: Looking back at my files, it was Delta Dental of Minnesota, not United that was to blame. Sorry United! Fuck You Delta Dental of Minnesota!

  15. Bryan Price says:

    I got told by my periodontist that my previous Aetna plan was the best. I’m now on MetLife Dental.

    Aetna was the best for me, the trouble was Aetna was trying to screw my periodontist. They were doing their best to not pay on certain things because they didn’t have documentation of one thing or another. Documentation which they definitely had.

  16. magic8ball says:

    @formergr: “how do people on minimum wage afford a root canal?” They mostly don’t. They wait until they’re in so much pain that they get admitted to the emergency room at the hospital, where they are prescribed painkillers that will enable them to put off their root canal a little longer. If they’re lucky, they’ll find a dentist that will agree to take a risk and finance them.

  17. Sir Winston Thriller says:

    @formergr: “how do people on minimum wage afford a root canal?”

    If they’re lucky enough to live in a city with a university dental program, they can get quality free or low-cost care from dental students (under the supervision of teaching dentists).

  18. chickymama says:

    I work in the medical billing world and dental billing is no different.

    If you are having issues with the usual and customary rates that insurance companies are paying, there are websites out there (I apologize that I don’t know their addresses) that can give the rates on procedures that doctors charge. More like an estimate. This is helpful if the reimbursement on a procedure is way less than what was promised or stated when the procedure was being prior authorized. If there is enough documentation, appeal it on the basis that your doctor (dentist) rates are within range of what others are charging for that procedure in that area.

    Don’t include a radius of like two or three offices. Do a radius of that metro area or if you are in a rural area..the county.
    On prior authorizations: if you are getting jerked around on what is required to obtain a prior auth, document this. Because if the procedure is denied due to no auth then it can be appealed on the grounds that none was given due to conflicting info by the customer svc reps. Most insurance companies are avoiding this by setting up dedicated depts that are devoted to just authorizing procedures. But there are still problems.

    One last thing, the benefit booklet that is given to you whether you are on a group policy or individual can be your best friend. Most customer svc reps will always fall back on this, stating something like “read your policy”, “look in benefit book” etc. Well if your benefit book states that you are only liable for 20%, then that is what you will pay. If a procedure is covered at 80% after usual customary…you don’t pay the difference. Normally that is a provider write off.

    I swear I should become a consultant..

  19. chickymama says:

    I forgot to add to the last sentence.

    You will only pay your 20% after U & C.

  20. Ass_Cobra says:

    Chickymama, you should. I don’t know how time consuming it is to get the insurance companies to bend over and pay what they promised but I would have paid someone 20% of the disputed amount to deal with the hassle.

  21. a-e-i-o-u says:

    You know that old saw about how dentists have the highest rate of suicide because they’re so despised? They should climb down off the cross. They’re not nearly as hated as dental insurers!

    See, the IDEA of insurance is lovely. It’s a great theoretical construct. It’s just that in order to keep on hauling in bigger and better returns for the shareholders (and you do understand that returns must always be BIGGER, because “just as obscenely profitable as last year” is not good enough) they’ve got to find ever more insidious ways to avoid doing what they’ve promised to do, i.e., pay up! Insurance companies in general, and dental insurance companies in particular, are designed to NOT pay claims.

    That said, if you masochistically enjoy tedious abuse, or you have plenty of time and a high threshhold for frustration (and it’s one of your proffered options at work), I recommend MetLife for your dental implants, presuming you’re planning ahead (and aren’t we ALL planning our emergency root canals in advance, hmmm?) MetLife is one of the few providers that has taken its collective head out of its collective posterior and begun to cover implant treatments at — get this — 90 PERCENT!!! Furthermore, they’ll cover crown and bridge over implants at 80 PERCENT, rather than 50!! Yes, ladies and germs, the most retarded segment of the insurance industry has discovered that modern technology that provides better care for average consumers ALSO fattens the bottom line! Holy smokes, stop the presses! You mean it’s not cheaper to provide mediocrity??

    Why did it take 25 years or more to figure this out? I guess it took them that long to notice that they might buy four crowns over endo in a 20-year period, but on an implant, not so much! Believe me, they don’t cover it because they love you, their valued customer.

  22. Anonymous says:

    I think Metlife leaves out information to scam you…
    Daughter needed braces. Called Metlife to see if it was covered under our dental policy. The employee said yes. Gave no other information. Made the appointment with Orthodontist. They even called Metlife. They drew up the payment plan going on what Metlife said was covered. Braces have been in my daughters mouth over two weeks. Got a letter stating she wasn’t covered. Turns out there is a 24month waiting period before braces are covered. Well why in the hell did they tell us it was covered? No one mentioned 24 months to us or the Orthodontist. Metlife now says you can’t go buy what their employees tell you. If I need information on my benefits because I couldn’t find the information on my own or don’t remember it stated when signing up and need to know this Why can’t I call the company I pay regularly for this informations? Why am I paying Metlife if I can’t go by what they tell me when I need information??? Our savings acount was drained paying Our “Half” of the bill and now becuase their employees left on one tiny piece of important information I have to come up with over $2000 more to pay the half I was told they covered? This is not right! Metlife needs to accept thier employees mistakes and maybed even train them for better customer service. I can’t afford $5000 braces, I surely would have waited if I was told that was what had to happen!!! One little sentence would have prevented our life from being turned upside down and a horrible debt we have to find a way out of over the next however many years!