Background Story

Teeth grinding. For a few months early 2017, I was constantly battling the decision whether or not to consult a specialist to rid myself of this nightly annoyance.

With my Great War of Debt in full-fledged battle mode, any dollars spent on getting treatment would directly swing the momentum back into the bad guy’s hands. Jack and I both agree, as would most in the PF community, that health (physical, mental, diet, etc) is top priority our life priority list.

Do you agree? Let us know in the comments!

The reason I hesitated was the same reason I’ve been holding off on getting new glasses – neither were of high importance. Because my medical condition doesn’t really trouble me much (almost like a sore knee or something similar) and my eye prescription hasn’t changed, urgency was low. In other words, it might not be worth the money to worry about it now – nonetheless, I decided better to keep it in check now.

The Beginning – The Free Consultation and Evaluation

I called the doctors office and scheduled an appointment, making sure they were on my insurance network and that the first consultation was free.

The first visit consisted of x-rays and some different test the doctor went through. The results were as expected, nothing major of concern but could worsen if left alone. He recommended getting a protective device to wear at night, leading me to the most important question of the visit: “How much will that cost sir?” 

The doctor replied, “Let us talk to your insurance for specific pricing, then give you a call.”

The Pricing Call

“After talking to your insurance, the price of your guard will be $450. We offer financing if needed to reduce the upfront cost”

I stewed on it for a few days and looked into the guard they were offering to make sure it was worth buying. My research found good results from use and the price with my insurance was actually a great deal – Let’s do this! I called to let them know of the decision and schedule a visit fitting of the appliance and updated my budget to include the new line item.

The Fitting and Follow Up Visit

Fitting and Payment

Visiting the doctor’s office again for the fitting, everything was going as planned. The device was fit snug and I swiped my card for payment afterward. Riding home that day, I remember thinking how nice the doctor’s office was and that I looked forward to working with them on getting this thing solved once and for all!

I forgot to mention that with the new device, an appointment every two-three weeks was required for the first 3 months ($25 each) for adjustments and a checkup. No problem for me, since this has to do with a very important asset, my smile lol!

A Nasty Surprise…

Two or three months passed. My regular visits went smoothly while the appliance was regularly being put to use each night. Things were looking great, well…except that one particular day I received a statement in the mail from the doctor’s office – $3,500 owed!!!

Shaken with surprise (thankfully in the morning), I wait until they open and give the business office a ring. They informed me that my insurance had not paid the amount agreed on. It was on me to that call them to get everything settled to avoid paying the extra charges.

Let me again remind you, that this device had been in my saliva for 2-3 months at this time – would Target misprice a swimsuit that you bought, put to good use in your vacation in Cancun, then call you to tell you that you need to pay more money because they mispriced it? Probably not…

The three-way call

Have you ever tried to be the middleman between business and insurance when you have no idea what is going on? Me either, instead I created a nice three-way call with my smartphone to let them talk directly. What resulted was a game of “who’s responsible”

Basically, the doctor’s office had called my main insurance company’s contact number (the one on the back of my card) instead of the subsidiary insurance office that handles the claim.

Who would have thought they would handle the same device differently?

I would consider this error on the insurer’s side, because the business office called them to get the quote, then was told the quote was incorrect when processing it through. They decided to retry the claim processing,  but with an adjustment, thus we ended the call on a good note.

Summarizing the call to feel more positive than it actually was, more like being on a call with two siblings arguing over inheritance.

Statement #2

Seeing nothing in the mail until the following month, I was hoping to see the balance removed and everything to work out. Not so. A new statement arrived including the same amount owed: $3,800, appearing as if my insurance did nothing to pay towards the device.

Calling my insurance to check on this, I’m told that this issue needs to be taken up to a higher level and I’m put in touch with one of the managers. I feel like I’m getting somewhere – the lead states that he’ll look into it and not to worry about it because it wasn’t my fault.

Sounds good boss man, take it away!

Statement #3

Guess what happens the following month? You bet ya! The same statement amount!! I was shocked. Immediately I call the doctors office to let them know I’m working on the case, hoping they don’t call a collection agency or something on me (adulting is hard!). They assured me it was fine as long as I was working on it.

Honestly, I’m a bit infuriated with my insurance lead in the heat of the moment. I take a deep breath, count to ten, and the dial number, then ask to speak to my manager friend who was looking into this for me…he was no longer employed at the company.

It is actually pretty hard to look into a case when you no longer work at the insurance company…

Back to square one. I tell a bit of the story and ask to talk to anyone who could assist me, request obliged. She briefs me on the official process to get the claim repealed and paid for, requiring an official repeal to be written (by me) and reviewed at their next board meeting.

Now we’re talking!! I write this baby up in fifteen minutes with my story, professionally stating my concerns and send it over. Now I wait…

The hearing must have ended well for me because they sent me a letter with their agreement to rework the claim for me! I was ecstatic!

A Pleasant Surprise…

Months later, around 3-4 months later, I see an envelope addressed to me from guess who? The doctor’s office. Feeling some dread on a potential new balance and the cyclical battle continuing, I begin slowing tearing open the statement envelope.

My facial expression turns from dread to dumbfoundedness!

It wasn’t a statement after all, but a check! $450 sent to yours truly! My insurance came through by paying for everything – the doctors office reimbursed me since I overpaid!

WOOHOO!!

Was it all worth it?

Absolutely!! I spent a total of two hours max rounding up the insurance calvary and writing the repeal. That’s $225 an hour! 

To me though, money isn’t the most important lesson from the whole story.

The take away I want to leave you with is this:

When put into a situation (money or life) where you feel that you have been wronged, misled, or wrongly placed responsible, then it is within character to stand up for yourself. Assertiveness and personal finance can go hand in hand, along with success and rational thinking for better decision making.

On the other hand, it is absolutely our responsibility to correct the mistakes we make in our life, both are imperative to being an amazing spouse, parent, and friend.

Thanks for reading!!

Have an interesting story that you could share? Leave a comment – we’d love to hear it!