Insurance

Please, don't get me wrong--I KNOW we have it pretty good when it comes to our insurance coverage. The problem is, we USED TO have so much BETTER coverage than we have now. Every contract, the union gives so much more back to the company, and it always seems to be our benefits. Anyway, I just want everyone to know how grateful I AM for what we have, but I still have to rant about our insurance.

Dental coverage. Orthodontics are only covered--50%--for anyone under the age of 19. I passed that a loooooooong time ago. We had to pay for my braces out-of-pocket. The bitch of it is, I didn't get them for the cosmetic appeal, I got them because of my TMJ and chewing problems. Of course, the problems I had were JUST beginning, so they weren't HORRIBLE medical problems when I decided to do something about them. But, our insurance (as most of them don't) doesn't pay for preventative, only pays to FIX a problem you actually have. Of course, it costs LESS to pay to prevent damage than to wait and try to fix the problem AFTER damage has been done--but insurance companies don't see the logic to that. (I must say, though, we DO have 100% preventative in terms of 6 month check-ups. They DON'T pay for adults to get fluoride treatments, though.) Now, I have gone back to grinding my teeth while I sleep--took awhile after the braces were removed, but I'm doing it again. At the rate I am going with the grinding, I will, eventually, break at least two of my molars and need them to be restored. Gold crowns--which is what I will need when the two teeth need to be fixed the next time--cost about $800 each. Our insurance company pays about 50% of the cost of a crown. To keep me from breaking my teeth, my orthodontist had a night guard made for me. This cost $400. The insurance sent me a letter yesterday refusing to pay any of the cost. But they would GLADLY (well, maybe not gladly) pay at least $800 to have at least two teeth fixed instead. It doesn't make sense to me.

I got my bill from the hospital for when I had to have the stitches in my leg. They charged $435. $200 went for the use of the room and $235 went for the doctor to put in 4 stitches. I still haven't gotten the statement from the insurance company. I don't have a clue as to how much of that bill we will have to pay. Every year, the insurance seems to change to a certain extent, so I NEVER have a clue as to what our out-of-pocket expenses will be. Every time I think I know what is going on, a statement comes and blows my thinking right out of the water. I THINK we will have to pay 80% of the bill, but I'm not sure if we have met our deductible yet. And I don't know if an ER visit is looked at differently than a regular doctor visit. And to top it all off, this is the first year we have to deal with this new insurance company. Oh, well, it should be interesting. Between my mouth guard, ER visit, and the crown that K is having done in the next month, we have a chunk of change going out. Yay. I love medical expenses.