Health Resources

Unfortunately, I didn’t have a choice of dental insurance providers. This is what the company had and so I went with it. After six years of paying in for dental insurance and not filing a claim once, I didn’t think it would be a problem when I chipped my tooth to get reimbursed for the services. I called Health Resources, asked them if I could file a claim from the UK since I was assigned by my company outside of the coverage area. The lady said yes I could and gave me all the information.
I filed two different claims, one for the emergency and temporary treatment and the second for the «permanent» treatment (turns out it wasn’t very permanent…). Anyway, I followed the instructions and even included the credit card statement for the one because the exchange rate the credit card company used was actually in their favor versus the one I pulled off the internet (they ask you to include a conversion rate). I thought I was being helpful. I know claims can take awhile, but a month later, I still hadn’t heard anything. So I called them. The lady on the phone was quite short with me, in fact most times I am trying to find things out, they aren’t very friendly.
She told me that the first claim had already been paid. «Really? Where was the check sent to?» I asked because I hadn’t received anything. «ADP Dental,» she said. So the thing that kills me about this, besides the fact that the dental office got paid twice for my treatment, is that three years ago when I asked if I could change my mailing address to the UK they said they couldn’t do that because they don’t send mail internationally and their computer system will not let them enter an international address. Fast forward three years and they are send checks internationally? So when I said that and questioned that they actually sent the check to England, she was like, «Huh? It was sent to the dentist’s office.» At this point I was frustrated and simply said, «Which is in ENGLAND.» She then said, «Oh. Well, just call them and ask for the money back.» Basically I’m never going to see that money again…
So the second claim, they said that they needed the tooth that was treated. I have the treatment plan that I faxed them and in two different places is clearly states the tooth and… wait for it… there is a diagram of all the teeth on there and the one that was treated is marked. Compared to the last treatment plan that only had it in one place. So she said I could fax it in again and they would review it again. Again didn’t hear anything for a few weeks, so I called. The lady I talked to this time (unclear as to whether or not it is the same woman) said the same thing, «We need to know which tooth.» I told her that I had refiled the claim and sent all the information again by fax. She said, «We need to know the surface otherwise this is invalid.» I wasn’t sure what she meant and asked her to explain and then told her which part it was. She said that it had to be from the dentist. Surprised she didn’t say, «Well, just call them.»
It occurred to me that they paid out on the first claim so I took a look at the treatment plan for that one and she mentioned that they have the history (because I explained on the fax that the first was the temporary treatment and the second was the permanent treatment. So I tried calling back a few minutes later and it went straight to voicemail. I doubt they will call me back and I am pretty sure that they are going to say no they can’t use the information from the other treatment plan. It is just frustrating that I followed their instructions, the dentist even sat down with their codes and wrote them on the treatment plans to make sure that the claim would go through. I never understood why people got so upset over claims and insurance before… mostly because I never filed a claim, but now… I get it. You pay for years and years for this insurance and when you finally file a claim and need the money, you can’t even get that money back… and it is just a tiny fraction of all that you have paid in. My sister is right, insurance is a complete and total fraud. I like the idea of nationalized healthcare now, mostly so I would never have to file a claim. Ever. Again.