Between a Rock and a Hard Place

It’s those seemingly little frustrations while living in Portugal or Spain that can make you angry and disgruntled, wanting or needing to rant.

Like going to the dentist.

I’m not referring to being treated by the dentist, which sometimes can be painful, but the whole series of complex procedures involved. Especially if you have dental insurance.

It had been a while since we’d had our teeth and gums cleaned, and wanted to check that off our bucket list. Cleaner teeth are easier to wrap your tongue around and actually feel smoother after brushing.

Our dentist, mind you, is great … it’s the bureaucracy, finger-pointing, and “not my responsibility” attitude involved. Plus, of course, all the time waiting.

Step #1—We log on to our insurance company’s network of affiliated providers, choosing “Dental” rather than “Medical,” “Well Being,” or “Hospitals” from the options. With the pull-down menus, we select our province, district, concelho, and specialty (general dentistry).

Step #2—We’re delighted to find that the clinic where our medical doctor practices tops of the list of three area providers that accept our insurance.

Step #3—Appointments are made, rescheduled, rescheduled again, and rescheduled once more. Internal matters at the clinic, you know.

Step #4—We show up on time (the scheduled hour, not the Portuguese one), check in with the receptionist, fill out a couple of forms, and wait for about 45 minutes before I’m called – the first patient in a full waiting room – into the dentist’s office. My partner will have to wait.

Step #5—The dentist and I exchange small talk as I’m seated in the curvy horror chair with all those awful attachments. Turns out, he’s just recently relocated to Portugal from Cuba. I feel somewhat better, knowing that, whatever else may be wrong in Cuba, its health care is known to be outstanding. The receptionist is role-playing dental assistant now, getting everything ready for the dentist (and me). She speaks Portuguese, not English or Spanish; the dentist can speak Portuguese, but prefers talking to me in Spanish. Throughout my 15-minute cleaning, he speaks Spanish into my right ear, while she speaks Portuguese into my left. Apart from all the head movements and rotations required, my head is spinning from trying to sort the two languages spoken simultaneously into my orifices. The cleaning completed, I’m told to rinse out my mouth with the water in the paper cup held by one of the chair’s many tentacles. I’m escorted back to the waiting room. It’s my partner’s turn now.

Step #6—As Russ undergoes an intensely long cleaning, I attempt to deal with a very flustered man seated in the receptionist chair, trying to find and/or organize records and documents scattered all around him. I hand him my insurance card, telling him to save us both time by billing of our cleanings so we can leave as soon as Russ is finished. After pecking at the computer, he pulls out binders full of papers and folders full of files. Nowhere can he find what he’s looking for. He picks up the phone and uses the intercom button to summon the receptionist (aka dental assistant) up front. Speaking a mile a minute in rapid-fire Portuguese, she returns to the dentist as the man behind the desk turns to me. “We don’t accept this insurance,” he says. Fortunately, I have printed out the dentists covered by our insurance plan, pointing out the clinic at the top of the list. He shakes his head, obviously at his wit’s end. “I’m sorry,” he shrugs in Portuguese. I hand him my Portuguese debit card and pay the 80 euros — @ 40€ per cleaning – figuring I’ll take the matter up with my insurance representative. Russ comes up front saying, “The dentist can’t do a full cleaning … my teeth are too tartared. We’ve got to come back.” We leave and head home.

Step #7—As soon as we’re home, I send an email to my insurance representative, explaining what had happened and asking him to, please, deal with it for us. Knowing all too well that it would be a while before receiving a response, I take care of some business and then return to the clinic the next day with Russ. He is seen by the dentist immediately.

Step #8—Half an hour later, Russ is back in the reception area. Turns out he has had more than a dental cleaning, but a tooth extraction as well. I don’t bring up the matter of insurance with the receptionist (last night’s dental assistant); I just hand her our debit card . At this point, I have three invoices and three receipts documenting my payments. We’ve paid €120 out of pocket to the clinic.

Step #9—Back home, I look to see if my insurance rep has responded. He hasn’t. I scan copies of the dental invoices and receipts, attaching them to the earlier message I had sent. I await his reply, I repeat.

Step #10—He replies, stating that the dental clinic is, indeed, a member of the insurance provider’s network. He attaches a file from the clinic showing all the insurance coverages it accepts. Ours isn’t there; but the rep says that our insurance company is part of another insurance company which is listed. “You will need to resolve this with the clinic,” he says, matter-of-factly. “The problem is with them, not with us.”

Step #11—We return the next morning to the clinic, assuming that – with insurance documents in hand – everything will be easy-peasy and we’ll be refunded our payments on the spot. Yeah, right. According to the very sweet receptionist, maybe four or five years ago, with a different dentist, the clinic accepted the “other” insurance (the one our insurance company alluded to) … but certainly not – ever! – ours. Who knew that insurance follows the doctor (or dentist), not the clinic? I hand her the email from my insurance agent and ask if she would be so kind as to call him while I stand there. She does, arguing with him over the phone for about twenty minutes. Smiling at me, she then says everything has been taken care of and that I should have a nice afternoon. “So, who is going to reimburse me the €120 I paid?” I ask her. “You’ll have to talk to your insurance agent about that,” she replies.

Step #12—Home again, I check my emails once more. Still no response from my insurance agent. I send him a new email asking him how this can be resolved: I’m between a rock and a hard place, out €120 because the dental clinic insists it’s not affiliated with my insurance provider and my insurance agent claims that it is. Really pissed at this point, I end my email reminding the agent that the signature line of his email shows his title as “Client Customer Service” and that customer service means more than paying bills and processing payments.

Step #13—Not much later, I receive the agent’s response: “Thank you for your email. Regarding the insurance company’s dental obligations, our agreement with the dental clinic is done through the company I mentioned,” he begins. “According to the clinic’s website, they have an agreement for dental treatments with that company—see the clinic’s insurance agreements on its website. As you can easily confirm, we provided you the same information that is mentioned in ours and the clinic´s records … which is that the clinic belongs to our dental network.”

God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.

##End of Rant##

Bruce Joffe is publisher and creative director of Portugal Living Magazine. You can read the current issue and subscribe, without cost, online: https://portugallivingmagazine.com/our-current-issue/

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