4.8 • 1.1K Ratings
🗓️ 19 December 2022
⏱️ 26 minutes
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When a car hit Susan and knocked out a bunch of teeth, her health insurance was supposed to pay for her oral surgery, and she knew it. So why has she had to chase them for 18 months and counting?
Getting insurance to pay for anything dental is usually hard, but this had us asking ourselves… is it usually this hard?
We connected Susan with law professor Jacqueline Fox — who, when she was practicing law, fought insurers on behalf of patients. And who says Susan has “done everything right.”
We’ve started to wonder whether Susan’s troubles could be related to broader accusations against her insurer, Ambetter, the largest provider of plans on the Obamacare marketplace.
Here’s a transcript of this episode.
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0:00.0 | Hey there! One theme we've been exploring for years on this show is we've got more legal rights |
0:05.0 | than most of us know about. And once we know the question becomes, how can we enforce them? |
0:11.4 | And as our story this time shows, it can be, and you're gonna see where I'm going with this in a |
0:15.5 | minute, like pulling teeth. All right, let's go. Susan Rice was out for a walk in her neighborhood |
0:22.8 | in Atlanta. It was a beautiful day. Just a bright blue sky. And I was just having a great |
0:29.8 | morning. Then she was crossing a big street and saw a car starting to make a turn in her direction. |
0:36.4 | And instead of going around me, he pointed his car right at me and accelerated. |
0:43.2 | And I looked at what would have been his face, but the windshield was tinted and I was like, |
0:48.4 | you've got to be kidding me, you're trying to kill me. I really thought he was trying to kill me. |
0:54.0 | Next thing she knew, she was on the pavement. I spit out a tooth when I sat up. |
0:58.7 | It's probably still there. Do you avoid that route these days when you walk? |
1:04.2 | Haven't been by since. I can't. Part of me wants to go find my tooth. |
1:09.5 | Of course, she's had to get that tooth replaced. Lots of others too. |
1:13.4 | And here's where things get messy. Because you're probably aware, health insurance generally |
1:18.4 | does not cover art. It's like they're not part of our body, whatever that's its own awful thing. |
1:23.0 | But what Susan needed was supposed to be the exception. As she told me, this wasn't the result |
1:29.2 | of poor dental hygiene. Her teeth got knocked out of her mouth by a speeding car. |
1:33.6 | Medical insurance is supposed to cover that. And she knew it. And now she's been fighting for a year |
1:40.3 | and a half to get them to pay attention. This is an arm and a leg to show about why health care |
1:46.0 | costs so freaking much and what we can maybe do about it. I'm Dan Weissman, I'm a reporter and I |
1:50.3 | like it's down. So our job on this show is to take one of the most enraging, terrifying, |
1:55.2 | depressing parts of American life, bringing you something entertaining, empowering, and useful. |
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