Pulling Hen’s Teeth

I called my dental insurance today and officially designated my chosen dental provider as my dental provider. It wasn’t a big thing, but it was a thing I needed to do and I did it today.

The need arose because I’d mistakenly presumed, early last month, that I could just show up to a dentist that was publicly listed as taking my specific insurance plan and get care. And then that when I checked in and they ran my insurance and said “all good” that this meant I was, in fact, all good. I did the x-rays, gagging and choking all the way. I did the crazy new technology where they scan all your teeth with a memorizing camera and the three-dimensional full-color digital image gets mapped on the screen in front of you, as though your chompers were the surface of a distant planet on which NASA had one good shot at choosing a landing spot. I got the upselling consult with the dentist, who mentioned that I was a great candidate for their version of Invisalign and, after just a year of constant constriction, maybe my migraines would be better in the long-term. And only then, when I went to billing and scheduling, slightly disappointed that two full hours in a variety of chairs hadn’t even gotten me a cleaning, did the person hit me with the bombshell:

“So you don’t have insurance? You’re doing this all out-of-pocket?”

Not only do I have dental insurance, I’ve been dutifully paying the family premiums for nearly two full years of gainful employment while cashing in on all of one (1) check-up for my son. Now to be clear, that’s not their fault. I could have been getting dental care here, there, and everywhere. I have a long and tortured history with dentistry, some of which I’ll delve into, and I’d just gotten a bunch of work done before we left West Virginia, and I had a new child and new job in the still ongoing pandemic. There’s every reason in the world to put off one’s teeth, especially when one’s history with them is so tormented.

Part of the problem is that teeth are one of those things that one doesn’t know how long or how well one can afford to defer them. My father died worrying a little about his teeth, thought admittedly he was worrying about everything at that point. His best friend in high school, a friend he retained well into his 30s, became a dentist. “He used to just talk about people who totally neglected their teeth. It was awful, disgusting,” he related to me after their friendship had more or less ended. “Garbagemouths, he called them.” A few weeks before his death, my dad sadly admitted to me “I worry about my teeth. It’s like Larry used to say, I’ve just become a garbagemouth.”

I’m not that bad yet, but I’m still insured even if I’ve neglected the insurance. So I blanched and balked and said “No, I have insurance. The woman at the front said it went through!”

“I’m not seeing anything here. Let me see your card.”

I don’t have a card. Cards are expensive for the insurance company to print and send. I have a faded paper printout of a card, grainy gray 6-point font as their aesthetic choice. “Oh you have an HMO. I think you have to designate a provider.”

“Great. I’m here. I designate you.”

“No, no, you have to call before you get the treatment.”

My stomach dropped to my shoes as I tried to calculate the costs of all those x-rays, all that time with the NASA scanner probing my gums. “So, wait? I’m on the hook for everything today?”

“Oh no, we wouldn’t do you like that. You just call the number and we’ll get you taken care of.”

I sighed audibly. That we could work with.

I expected to call the next day. But that day, I unexpectedly won an award at work and we went out to a lovely Thai dinner in Manayunk. And then it was Friday and I got swept up in the weekend. And the next week, we flew to Disney World. And the next week I had to catch up from taking time off to go to Disney World. And the next week I had a thousand deadlines. And on the Friday of that week, my dad died while we talked on the phone at 9:00 Eastern (7:00 Mountain).

It’s taken me till today to get over the inertia and call about my teeth. And tomorrow, I have to actually call the provider back and report that it took me 50 days, but here I am, ready to get my cleaning and fix my broken tooth, and then maybe fill a couple cavities and then, no, thank you, I’m good without the alignment service. I’m worried that it’s been long enough that they’ll want to redo the x-rays.

My dad wouldn’t have let me get the x-rays in the first place. He shepherded me around to most of my many dental appointments as a child. They always wanted to get the x-rays and he was terrified of the radiation and what it would do to me, a son of a mother who’d gotten breast cancer, a son of duck and cover and the atomic age. It almost became routine, we would check in, fill out the forms, they’d ask me to step back this way and put on a lead apron, and my dad would start asking questions. “Why does he need this? Can’t you just look at his teeth? No, we’re not doing the x-rays.” Sometimes the dentist would back down and begrudgingly look in my mouth or do a cleaning, usually to say he needed to pull teeth but couldn’t without x-rays. Sometimes the dentist would refuse to do anything more and we would leave. At least once, the dentist convinced my father to allow two small x-rays on a very narrow part of my jaw for a particular procedure.

My adult teeth came in in a second row like shark teeth, behind my baby teeth, trying to coexist rather than dislodge them as nature intends. I had tens of them pulled by the time I reached my teens. A few fell out naturally, but the ritual of wiggle and gently pull or have them come out in an apple or piece of candy wasn’t much of my childhood. The tooth fairy’s visits were hard won in my house, the result of procedures denoted by lots of novocain and a little blood (after one early disastrous incident with “laughing gas” that I found disorienting and ultimately unbearable; I still report this as an allergy on new dental forms).

Most of my successful interactions with the dentist wound up being at university dental clinics. With my family’s income low and my dad’s patience for for-profit dentistry waning, these clinics were an oasis of affordable (sometimes free) care provided by eager and patient young people. The appointments were even more time-consuming, but we had the feeling that people were really listening to us. It was this habit that I maintained when, in New Orleans and having neglected my dentistry again, then having escaped a terrible boss to instead join the gig economy, I found myself again short on insurance and long on time. I spent hours with wonderful dentists at the LSU Dental Clinic in New Orleans, then at WVU’s own Dental Clinic in Morgantown. Just in time to let things go again here in Philly.

I’m expecting some fights. No, not with the x-ray tech. That’s something I can’t really bear to resist, not after years of feeling sheepish about my father’s virulence in fighting the procedures as a youth, not after hearing so many beleaguered explanations of why they were so important. If I get cancer in my jaw or mouth (“deprogram,” I can hear my father saying), then I’ve made a grievous error and he was right all along. But I’m expecting more fights about the billing. I have insurance and Alex has insurance and Graham has insurance and there’s maybe two bills out of twenty we’ve received since getting this insurance that have been properly allocated. Everything’s a fight. It’s just the nature of contemporary capitalism that most companies and corporations either deliberately overbill and count on people to not have the time, commitment, and understanding to properly fight back or that they can save money by not doing things consistently and properly and let the chips fall where they may. Malignance or neglect, it was a debate my dad and I had frequently. I tended to see neglect where he saw malice, but he was always better at fighting both. I was sometimes mortified by how hard he fought on some of these issues, but as an adult I’ve come to really appreciate his diligence and tenacity for the fight. It’s as necessary a skill in modern America as knowing how to drive or operate a cell phone.

But, as my dad said often, it’s like pulling hen’s teeth. My dad never met a metaphor he couldn’t mix, and some of his favorites became idioms of his own making, to the point where I’ve almost forgotten what was original and what was his adjustment. Pulling hen’s teeth may have been the single best of these, though. For of course hens don’t have teeth, which makes pulling them all the harder.