Another thing

Another thing that churns up my stomach acid so much that I can’t see, walk, or cry is the dentist. Even if you are a lucky man, and have a job with medical and dental insurance, and make a little bit of money, going to the dentist is a little bit like spinning a wheel to find out what method of execution the state will be using. Let’s try the old compare and contrast method here:

Scenario #1 – Something is wrong with my foot

Something is wrong with my foot. It hurts, even when I’m not doing things like kicking a wall or shooting myself. It is a dull ache and does not prevent me from walking, so I call and make a regular appointment. Usually it will take about a week to get a non-emergency appointment, but sometimes it’s as soon as the same day. Upon arrival at the doctor’s office, I pay them $5. This is a ritual transaction that covers none of the actual cost of my treatment but deters hypochondriacs who may not have a lot of walking around money this month. The doctor examines my foot and determines the most likely cause of my pain. If necessary, the doctor refers me to another doctor, and the process is repeated. If I need an X-ray, that will cost me $10 more. (This, I secretly suspect, does actually cover the cost of my X-ray, because it is all digital now and it only requires a few minutes of the technician’s time.) If the doctor decides to give me narcotics for my pain, the prescription costs me $5 to fill. If I need a cane or crutches or a brace, I get those at a tremendous discount.

My foot problem has cost me less than $20, most likely.

Scenario #2 – Something is wrong with one of my teeth

Something is wrong with one of my teeth. Again, it is not an emergency, so I call for an appointment. This is kind of a wild card, because my dentist works in a very small office, and his schedule is pretty booked. But I’ve had good luck here, so let’s say this again, takes around a week, and maybe the very same day. When I arrive at the building, I don’t pay any money up front. This is because they want me to be able to smile in the exam, and also because if a hypochondriac were to wander in with an imaginary complaint, the doctor has a variety of whitening, straightening, and other cosmetic processes to offer. I am taken to a room and asked briefly about the tooth in question, and then given a full set of X-rays to determine whether or not the rest of my teeth are sound. The dentist recommends a course of treatment for my tooth, and any others that may be offensive, and then leaves the room. A special kind of lady then walks in. She is not a dentist, but she is very good at talking to insurance and credit companies on the phone. She hands you a sheet of paper with an alarmingly high number on it. This number is usually equivalent to between 50 and 100 foot treatments. On one of the lines on the sheet, she has estimated how much your insurance will pay. This number is a guess that a computer makes. The piece of paper lists some options for you, though they are usually all bad. Options include “Pay us now for any dental work we think we can convince you you need,” “Pay us 20% of that mess now, and pay for each treatment as you get it done,” and “open a new line of credit to pay us.”

After you have paid them, they give you another appointment, in about a week, and you come back and have your mouth repeatedly violated.

At some point, 6 weeks or a month later, you get a letter from your insurance provider. It can say one of four things: “we paid $x to your dentist,” where x is much more than the computer estimate; “we paid $y to your dentist,” where y is the exact amount of the estimate; “we paid $z to your dentist,” where z is alarmingly less than the estimate; or “we don’t think we have to pay anything. Here is a number you can call if you’d like to cry tears of humiliation and rage into your phone.” Clearly the first scenario is best, since you are theoretically entitled to a refund from your dentist, but even this is not an out-and-out positive scenario because, like the government, your dentist doesn’t pay you interest on the money you have overpaid, and there will always be a followup visit in which it is casually mentioned that you have credit towards your next terrible violation.

Dentistry is the worst

Which was to be demonstrated.


Appendix A – A Working Couple

You and your spouse both work and both have insurance. You are now, theoretically, double insured. You should, therefore, always get insurance letter 1 above, but instead, both companies will decide that they are not liable for your dental work, so you will get duplicate insurance letter 4’s. Expect this.

Appendix B – Teeth

It is impossible to have a perfect set of teeth. Up to your teenage years, teeth will spontaneously fall out. During your teenage years, your teeth will not be straight enough. As an adult, your teeth will be decaying. You have millions of years of evolution behind you, but only for the last 500 years has it been common to live to see 40, and only for the last 50 has there been an expectation that a 40 year-old would still have all of his teeth. Animals that are serious about teeth have a lot more of them and regrow the ones that fall out.

This is a perfect setup for the dentist, because there is always something he can fix. If, however, he has been beaten to the punch, there can still be something wrong with your gums. Examples include too pink, not pink enough, too puffy, and not puffy enough.

Appendix C – Other types of coverage

It is possible that your medical or dental coverage doesn’t look like mine. That’s okay, because that’s fine. Actually going to the dentist is still terrible. For instance, consider that full X-ray series. When you go to the doctor because you have a cough, they don’t do an MRI looking for other things they can fix. Doctors still want to make money, but they are way less into drumming up their own business. Even a simple cleaning is like one of the circles of hell. Not one of the major ones, like for fornicators or regicides, but one of the peripheral ones, for–I don’t know–people who under report use tax to the state.

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