Hello AAM community. I am having a dental insurance issue that is tied to my job, and hoping anyone that works in or is familiar with insurance or HR policies can offer some advice.
I work for a large private university in Massachusetts. Let’s call it Cheap Ass Uni, or CAU. I am staff, not faculty. We have pretty good medical benefits through Blue Cross Blue Shield.
For dental insurance, there are two choices. CAU has its own dental clinic, and one of the dental insurance coverage possibilities is to only use their centers. It’s dirt cheap, but the wait times are abysmal, and it feels like being in a dental assembly line.
The other option is a regular Blue Cross Blue Shield (BCBS) dental coverage. You can still go to the CAU centers, but you also can go to other dentists as long as they are in the BCBS network. I will call it the “open” choice.
I clearly remember choosing the open plan, so I would have other options. My husband remembers sitting with me and me choosing this as well.
In the winter of 2024, a bothersome tooth abscessed, causing more pain than I have ever felt, (and I have kidney stones). Because it was the holidays, the CAU centers were closed. I found a dentist that is near where I live (not in the same city as CAU) and available. I logged on the BCBS and saw that this dentist was in the open plan network. So I went, and got antibiotics for the abscess.
In March I got a root canal and crown at that dentist. I am responsible for 60% of major restorative work under the open plan after the deductible is met, so I paid the $2700 for that up front. I am long past the deductible being met.
A couple weeks ago, I got a bill from the dentist for $2000. When I called the dentist, they said insurance will not pay a cent for the procedure. I called BCBS and they said while I have that open plan, I still have to go to CAU centers unless it’s an emergency. That is blatantly not what CAU’s website says, which says you have the choice to go to a dentist you choose in the BCBS network. Unfortunately the dentist adamantly said it was not an emergency.
I contacted CAU’s HR about it, hoping they could help. They are insisting I have the CAU only plan, even though BCBS says I have the open one. I have been going back and forth with HR, and they said my paycheck reflects I have the CAU plan. I looked it up, and, unfortunately, they are right.
But someone, likely CAU, made a massive error here. First, I am certain I did not sign up for the CAU only plan. HR said I should have known this from my paystubs, but when someone looks up their benefits, they typically do so by logging into the provider, not by looking at their pay stubs. I was also in pain and desperate. But again, BCBS says I have the open plan! I have provided HR with screenshots, but they have no answer for me.
The other discrepancy is that the BCBS rep I talked to was completely in the wrong about what the open plan is.
CAU refuses to take any responsibility or even give me an explanation of what happened, and HR is getting annoyed with me and saying things like “As we already said…” So I contacted our ombuds department, and am talking with one of them on Friday. The most they can probably do is mediate a discussion between me and HR.
I did just talk with an ombudsman and my supervisor, who is also an HR employee. I am going to write up what happened and send it to them, who will then contact the head of HR. They might be able to help.
Do I have any recourse here? I maxed out my credit card for the first $2700, and it will take at least 6 months to pay off the other $2000. I also just feel I should not have to pay for something that is not my fault. Thank you.
