tale of two insurances

Roxann
Winchester , VA
Heathcare Status: Employer Insured

I work for the public sector which generally has enjoyed some of the best insurance overall for the least price however this too is a thing of the past. My family policy with dental costs almost what my mortgage does each month and my husband and I wonder how long we can continue to afford it. Especially since most of the doctors we saw last year were not covered and each month I get another notice that more and more of my doctors have chosen "not to participate". Last december I broke tooth and called my dentist a week before Christmas (it was a Tuesday). I was told that the dentist was closing the next day early and they would not be opening again until the 12th of January. When they returned I was allowed to call for an appointment and they would "try to fit me in" - it was a month without dental care. But by Friday night the tooth had begun to abcess. The backup dentist was out of his office until the 8th and no other dentist would see me on a weekend especially before a holiday so eventually I got to be in such pain I finally went to the only thing open - the local hospital emergency room. After all I had paid a premium for both medical and dental insurance - I figured I would be covered for any hospital bill. WRONG. All the hospital did was give me a prescription for antibotics and a painkiller to get me a month out for the dentist. The cost for that 15 minutes was $435. The medical insurance denied it - it was dental. The dental insurance denied it - service was not performed by a dentist. So with all that insurance I still had no benefits. Since we live in an area that has few dentists and fewer that work full time. My dentist only works 19 hours a week and we have no emergency dental clinics. Therefore the insurance company limiting care to dentists only is like no coverage at all. This year my out of pocket expense for insurance and medical bills topped $7000. Of those expenses the insurance paid - $316. That's is right I paid $7000 for $316 worth of coverage. And we are healthy people. The bills included $514 for a hospital bill for my son hurting his hand (insurance paid $57) and my husband's "free" annual exam (sure the exam was covered but NONE of the tests the doctor ordered to measure his health was covered)costing hundreds. I know my story is minor in the face of some of the stories of terminal illness and bankruptcy. But like a lot of families I questions when - if I have a 51% chance of going bankrupt IF someone gets really sick or hurt even insured - why am I paying a premium for it?

Submitted on December 5, 2007 - 7:35am.