PATIENT'S RIGHTS

Looking at the clock, the numbers stared back at me. The digital reading was 6 A.M. Trying to go back to sleep but was wide awake. It was Monday morning the 23rd of January. There was a priority task on my to-do list. The priority was to call my medicare advantage plan and speak to their customer service representative.

While we normally have breakfast between 9:30 - 10:00, this wasn't a normal morning. Before 7:30, gathered all ingredients together for our triple-berry nutty smoothie. With all ingredients in the Vitamix, within minutes, we had thirty-two ounces of creamy and flavorful breakfast that we could share.

At 8 A.M., dialed the number on the back of my advantage insurance card. After all the automated telephone messages and prompts, a person answered. Spoke to Mayela. This is not her real name but the name that was captioned on my phone. Explained my concerns about their in-network dentist and all that was wanted was a regular cleaning. Informed Mayela that the recommended treatment was a deep cleaning. The deep cleaning wasn't wanted or needed and didn't feel comfortable with the procedure and treatment.

With four individuals in the in-network dental office insisting that I have a deep cleaning, my request and feelings weren't being considered. Naturally, I felt like I was being coerced. Informed Mayela that my appointment with the in-network dentist was in a few hours.

Mayela understood my concerns. Reminding me that I have an active medicare policy effective since January 1, 2023, Mayela said, "The deep cleaning is just a recommendation from your dentist, but it's up to you what type of cleaning you would have for your teeth. You're the patient. So, you will decide what type of cleaning you would have for your teeth because you have the rights as a patient to decide...

Do you want me to send a copy of the benefits so you can review all the covered services under the plan?"

Agreeing to have the benefits pdf emailed to me, Mayela continued, "Upon checking here you don't have any deductible and your annual maximum is $1,500, and no waiting period. Yes, regular cleaning is 100% covered for both in and out-of-network twice a year. But, I highly suggest that you should visit an in-network dentist because if you visit an out-of-network balance billing may appear and may apply. You might end up paying more out of pocket."

Asking for my email address to send a pdf of benefits, she made sure that the email was received at my end. Confirming that the email came through, Mayela asked, "What was the name of the in-network dentist?"

Gave Mayela the corporate name, their address along with the name of the dentist seen on the 19th of January.

Before the call ended, she gave me the reference number, and Mayela reminded me of their online website address. In closing, Mayela said, "Don't hesitate to call us back if you have more questions."

****

Twenty minutes before my appointment time, arrived at the in-network dental office. Walked into the dental office. Noticing the cold and unwelcoming vibes, approached Mr. J and informed him that I didn't feel comfortable having a deep cleaning and that as a patient I have the right to have the treatment of my preference according to my medicare advantage plan customer service representative.

Mr. J said something that wasn't audible. Then, Miss Z in the front office said words that couldn't be heard. Mouthed the words, "Can't hear you." Then, Miss Z walked to the counter.

Miss Z said, "The hygienist couldn't do the regular cleaning. It would jeopardize her license. It's illegal to do a regular cleaning when a doctor recommends a deep cleaning."

Reminding Miss Z about my conversation with my medicare advantage plan customer service representative who informed me that as a patient I have the right to have the treatment wanted and felt comfortable with.

Quickly, Miss Z retorted, "Your insurance is responsible to you."

At that point, was thinking that the dental office agreed to participate in the medicare advantage insurance plan becoming an in-network office.

"You are telling me that your office can't do a regular cleaning because it would be illegal!" I exclaimed.

Miss Z said, "Yes!"

We came to an impasse.

Finally, Miss Z announced, "We can cancel."

Was in agreement with that. Asked if they could email my x-rays to a dentist.

Miss Z replied, "The x-rays can only be emailed to you."

With that, I left the building.

Made a beeline to my dentist's office which is out-of-network. The drive was less than two miles and parked in front of their building. Having over a four-year relationship with them, their office is warm and welcoming. Ms. L greeted me.

I gasped, "All I wanted was a regular cleaning."

Ms. L asked, "What happened?"

Of course, told her what had transpired. Remarkably, she had an opening for 10 AM. the next day. Yes! My cleaning appointment was made.

Ms. L said, "Have the other dentist's office email us the x-rays."

"They won't!" I answered. "They will only email the x-rays to me."

Since my dentist needed the x-rays for the following day's appointment, decided to drive back and have them email me while in their office.

Before leaving Ms. L said, "Beside the x-rays be sure to get the perio chart."

Taking the time to write down what was needed for me, Ms. L is so sweet.

Drove back to the in-network office. Once inside their office, I requested the x-rays and the perio chart to be emailed while I waited. Within minutes, received an email with two pdfs and again left the building.

Inside the van, opened the email to review the pdf. There were x-rays but the perio chart wasn't included.

One more time, walked to the front counter.

I declared, "There are x-rays but there wasn't a perio chart."

Leaving her chair, Ms. Z approached me, she said, "Every hygienist has their evaluation."

Offering to write down the numbers, but Ms. Z wouldn't countenance that.

Obviously, patients have the right to see, review, and obtain copies of their records that the dentist owns. What is their problem?

Asked Ms. Z, "Will I be charged for today?"

Ms. Z shook her head no.

After leaving Ms. Z and inside the van, sent an email to Ms. L with x-rays and a note that they wouldn't provide the perio chart reiterating what Ms. Z told me.

Once more, stopped by my dentist's office to confirm that the email was received.

Ms. L confirmed that she received it. We were at a loss to understand why they couldn't provide me with a copy of the number on the perio chart.

As Ms. L said, "Numbers are numbers."

****

Tuesday morning, the 24th of January, back to my dentist's office and met with Mrs. V, the hygienist. Mrs. V was fabulous. Believe it or not! While my teeth were being cleaned, we had a wonderful time.

It should be noted that aging does cause gum recession.

Furthermore, Mrs. V said, "A deep clean wasn't warranted."

As you may have noticed, a dentist always reviews the hygienist's work. Since my dentist was out on medical leave, another dentist filled in and reviewed Mrs. V's excellent work.

Definitely a difference between offices, it was like night and day! In addition, Ms. L was delighted that I was happy with the cleaning.

As for my six months' cleaning, that's already scheduled. The out-of-pocket expense of seeing an out-of-network dentist for regular cleaning has yet to be determined.

While the benefits pdf shows both in-network and out-of-network are at 100%, it is based on what the medicare advantage plan decides as payout for procedures. That amount isn't given on the benefits plan information.

As a matter of fact, the in-network dentist accepts that amount and doesn't bill the patient for the difference while the out-of-network dentist can charge the patient the difference.

In conclusion, patients have rights. Don't be bullied into a treatment that you don't want or don't feel comfortable with.

In case you missed part one, you can find it here.