Conference 7.286::digital

2070.0. "Health insurance potholes" by CFSCTC::CORZINE (Gordie 244-7083 ako) Tue Aug 25 1992 15:22

    Finding the gaps in our myriad health insurance offerings is
    nightmarish.  Perhaps, by sharing our experiences we can all be better
    informed and prepared.
    
    Here's my latest story.  It's all documented and by the plan, but it
    hurts all the same.

Normal enough problem.  According to the family dentist our 18 year old
daughter needed all four wisdom teeth removed.  He recommended an oral surgeon.
Teeth are impacted but not infected.

Follow the process:

o  Obtain predetermination of benefits.  Dental surgeon estimates this will
   cost $1,100 ($275 per tooth), so we advance the $500 based on Digital's 
   projected benefit of $600.

o  Four wisdom teeth a bit heavy for office work, so go to local hospital
   surgical center, and have general anesthetic.  We were told by dentist
   that our medical insurance would cover these expenses (not entirely true).

o  During the procedure, they find an unexpected 5th wisdom tooth that is 
   taken out.  Going the hospital route was a good, conservative decision.

Our coverages are supposedly pretty good:

1)  Dental plan
2)  Healthnet with Harvard Community Health Plan
      70% coverage after $350 pperson deductible, if not covered by HCHP

Because the wisdom teeth were not infected, HCHP would not cover any expenses.

It looks like the results are:

           Total     Total     Insurance Total
           Expected  Actual    Benefit   we pay
           ------    ------    ------    ------
Dentist     1,100     1,375       750       625
Anestesia               520       187*      333
Lab work                 48        34        14
Hospital              1,082       757       325
                      -----     -----     -----
                      3,025     1,728     1,297

  *  reduced because 267 applied to deductible

Note that if we had been straight on the HCHP plan without the Healthnet
additional coverage, it would have cost us an additional $978 (a total of
$2,275)...  Just to have our daughter's wisdom teeth removed.  

This is good insurance coverage?