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Subject. Choosing our HMO.
We are considering switching our HMO to Blue Cross from Kaiser as a way of saving considerable amount of money. However the issue that concerns us most is the reliability of Blue Cross being there for us if we ever needed them.
Neither one of us has any medical problems or prior experience with Blue Cross However, Blue Cross Senior HMO provides a dental plan that uses the same dentists that that are used by Health Net and Secure Horizon. We dropped that dental plan after several instances occurred that made us suspicious that the dentists were using the HMO's referrals to deceive elderly retirees.
The first instance occurred with dentist Stratford Jones of Ventura Ca. who is under contract to Health Net, Secure Horizons and Blue Cross. He informed me after taking his routine X-ray that a crown on a molar had to be replaced because of decay under it. I was having no problems with that tooth but accepted his word at my cost of $450. He showed me the X-ray but I could not tell anything. I asked for the crown he removed and discovered it was made of porcelain covering a hollow metal substance. How can an X-ray take a picture of a tooth inside a metal object I asked myself? He did not work on the tooth at the gum line or below the crown. I became suspicious about dentist Stratford Jones.
Another time I had a problem with a tooth and asked for an appointment. I was told I could not see Dr. Stratford Jones for two weeks. Although it was two weeks from the time I called, the Office considered it an emergency call and charged me. At that time dentist Stratford Jones wanted to remove the tooth and replace it with partial dentures at considerable cost. My daughter recommended that I go see a doctor Stewart in Santa Paula. He took an X-ray and determined that there was enough of a healthy substance deep in the gums that he could use to rebuild the tooth. I had to have a small operation to cut my gum so he could work. It has been about three years now since he restored the tooth. Since then I had to have two other crowns from other teeth replaced because of decay. The crowns broke from the tooth when the time came. Because of doctor Stewart, I wear no dentures. The only time after my initial visit that Dr Stewart used X-Rays on me was for root canals and setting posts or evaluating the method of repairing a decayed tooth. I do not recall him ever using X- ray for general examinations as Dr Jones did.
I had visited another dentist under contract to Secure Horizons dental plan. When I questioned the Office Manager, she informed me that unlike regular doctors, the dentists
Compensation from the HMO's is almost nothing. .
Although all this has occurred some time ago a friend just recently reminded me of it all. He was upset after he had his semi annual teeth cleaning at Stratford Jones. "All they did was polish and whiten my teeth" he exclaimed. I told him doctor Stewart’s dental hygienist. Scrapes the plaque from my gum line and inspects for any decay or start of cavities. She does not just polish my teeth. I expressed to him from my experience that HMO discount dentists are no bargain. He wanted from me the phone number of Dr. Stewarts Office.
We get the feeling that Kaiser does not include a dental plan because they are more interested in their patients well being then in using dubious schemes to appear like they are giving more value.
We hope we can get an answer to our concerns so that we can make a decision.
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