Hey AAM group. I’m having a dental insurance coverage concern that’s tied to my job, and hoping anybody that works in or is accustomed to insurance coverage or HR insurance policies can supply some recommendation.
I work for a big personal college in Massachusetts. Let’s name it Low cost Ass Uni, or CAU. I’m employees, not college. We’ve got fairly good medical advantages by way of Blue Cross Blue Protect.
For dental insurance coverage, there are two selections. CAU has its personal dental clinic, and one of many dental insurance coverage protection potentialities is to solely use their facilities. It’s grime low-cost, however the wait instances are abysmal, and it looks like being in a dental meeting line.
The opposite possibility is an everyday Blue Cross Blue Protect (BCBS) dental protection. You possibly can nonetheless go to the CAU facilities, however you can also go to different dentists so long as they’re within the BCBS community. I’ll name it the “open” selection.
I clearly bear in mind selecting the open plan, so I might produce other choices. My husband remembers sitting with me and me selecting this as nicely.
Within the winter of 2024, a bothersome tooth abscessed, inflicting extra ache than I’ve ever felt, (and I’ve kidney stones). As a result of it was the vacations, the CAU facilities had been closed. I discovered a dentist that’s close to the place I dwell (not in the identical metropolis as CAU) and obtainable. I logged on the BCBS and noticed that this dentist was within the open plan community. So I went, and obtained antibiotics for the abscess.
In March I obtained a root canal and crown at that dentist. I’m accountable for 60% of main restorative work beneath the open plan after the deductible is met, so I paid the $2700 for that up entrance. I’m long gone the deductible being met.
A pair weeks in the past, I obtained a invoice from the dentist for $2000. After I known as the dentist, they mentioned insurance coverage is not going to pay a cent for the process. I known as BCBS and so they mentioned whereas I’ve that open plan, I nonetheless must go to CAU facilities until it’s an emergency. That’s blatantly not what CAU’s web site says, which says you could have the selection to go to a dentist you select within the BCBS community. Sadly the dentist adamantly mentioned it was not an emergency.
I contacted CAU’s HR about it, hoping they may assist. They’re insisting I’ve the CAU solely plan, though BCBS says I’ve the open one. I’ve been going backwards and forwards with HR, and so they mentioned my paycheck displays I’ve the CAU plan. I regarded it up, and, sadly, they’re proper.
However somebody, seemingly CAU, made a large error right here. First, I’m sure I didn’t join the CAU solely plan. HR mentioned I ought to have identified this from my paystubs, however when somebody appears up their advantages, they sometimes accomplish that by logging into the supplier, not by taking a look at their pay stubs. I used to be additionally in ache and determined. However once more, BCBS says I’ve the open plan! I’ve supplied HR with screenshots, however they haven’t any reply for me.
The opposite discrepancy is that the BCBS rep I talked to was utterly within the mistaken about what the open plan is.
CAU refuses to take any accountability and even give me an evidence of what occurred, and HR is getting irritated with me and saying issues like “As we already mentioned…” So I contacted our ombuds division, and am speaking with one among them on Friday. Essentially the most they’ll most likely do is mediate a dialogue between me and HR.
I did simply discuss with an ombudsman and my supervisor, who can also be an HR worker. I’m going to jot down up what occurred and ship it to them, who will then contact the pinnacle of HR. They may have the ability to assist.
Do I’ve any recourse right here? I maxed out my bank card for the primary $2700, and it’ll take no less than 6 months to repay the opposite $2000. I additionally simply really feel I mustn’t must pay for one thing that’s not my fault. Thanks.
