Dealing with United Health Care is like pulling teeth

Dentist examines woman at clinic for people without health insurance I want the same kind of health insurance that Luci Baines Johnson, the youngest daughter of President Lyndon Johnson, has.

The 62-year-old Johnson recently was flown by air ambulance from Dallas to the Mayo Clinic in Minnesota for what doctors suspect is a rare, autoimmune disorder affecting her nervous system. Flown by air ambulance?

No disrespect intended toward the former President, his family or its wealth, but being flown by air ambulance to one of the world's best hospitals sounds plenty expensive and somehow I think isn't anything my health carrier, United Health Care, plans on doing for me or my family any time soon.
In fact, I can't even get them to pay for an oral surgeon. Here's my tale, and I promise to listen to yours:

My 12-year-old daughter needs braces. I took her to an orthodontist who did panoramic x-rays, took molds and delivered the bad news that before the braces could go on, she needed to have 5 teeth pulled. He sent us to an oral surgeon armed with a "yank her teeth order" and our x-rays -- and therein lies the rub: United Health Care doesn't think the oral surgeon should be paid for examining her -- just pulling her teeth, apparently.

It seems that our policy only covers a fixed number of dental exams within a year and to have her "examined" by the oral surgeon before April 24 would exceed our paid-for allotment. Mind you, neither of these oral practitioners has cleaned her teeth or checked her for cavities. Those preventative services will require a third dentist examining her, which I think is a safe bet won't be covered once these first two guys are done. Maybe in 2014, if Obama's health plan continues on schedule.

Now some might argue that the oral surgeon doesn't really need to examine her before he pulls her teeth. But I would wager that that notion wouldn't sit well with his medical malpractice insurer. Besides, would you really want to go to a surgeon who simply did what another doctor told him to do?

What's the logic behind United Health Care's policy? They don't want people to abuse the system by dentist hopping -- meaning what? Getting another opinion? Since the orthodontist is recommending that the oral surgeon pull one of my daughter's permanent teeth, I don't mind hearing another viewpoint.

The truth is, like most things in life, the devil is in the details. Nobody checks their insurance policies at this level before they sign up for coverage -- assuming here that you can even find an insurer to cover you. But once you do find an insurer and they cash those not insignificant premiums, how are you supposed to know that you had your annual mammogram a day too early for it to be "annual," or that your insurer doesn't cover the virtual colonoscopy that your husband's gastroenterologist insisted upon because of an elongated colon but would have covered (at least partially) the plain old up-the-you-know-what kind. Yeah, they got me on both of those too.

It's little comfort to know that I'm not alone in the absurdities department. When Lorin Oswald of Wisconsin worked for Humana, she was excluded from coverage of any health care connected to her sinus infections because they were pre-existing conditions. For those who aren't sinus sufferers, let me assure you that the treatment is typically a round of antibiotics. And she was one of their employees at the time.

Or there's the case of Barbara Saunders of Northern California, who recently fell and broke a tooth. She saw her dentist the next day. The dentist conducted an emergency exam, X-rayed the tooth and another one suspected to be damaged, and then temporarily bonded on the broken piece of tooth until she could see a specialist to confirm the need for a root canal. Assurant, her insurance company, denied coverage because they said her policy doesn't cover emergency exams when they are given at the same time as other services. such as the "palliative service" of gluing on a piece of broken tooth.

I'm not saying insurers are wrong in setting limits on what they will pay for. I'd just like to have a copy of the rule book so we play the game more fairly.

Your turn, readers ....
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