Dentist Challenges Denied Insurance Claim

USA: What began as a standard dental cleaning for an 83-year-old patient in Pueblo West has escalated into a public confrontation between a local dentist and one of the nation’s largest insurance providers. Dr. Taylor Ross of Pueblo West Neighborhood Dental and Implants, who has served the community for eight years and practiced dentistry for over three decades, found himself at odds with Humana after the company denied coverage for a routine procedure.

The elderly patient, who struggles to clean his teeth due to limited hand mobility, visited Dr. Ross’s office in December. “So we took pictures of his teeth and then cleaned them. Pretty routine, right?” Ross said. According to Ross, Humana had assured full coverage for the cleaning under the patient’s policy. However, the claim was later denied, citing “no evidence” for the necessity of the procedure.

Dentist Takes a Stand

In response to what he describes as a “significantly egregiously wrong” decision, Dr. Ross decided to take action. Outside his practice at 120 S. Stardust Drive, adjacent to U.S. Highway 50, a digital billboard now displays images of the patient’s teeth before the cleaning, alongside the name of Humana’s CEO, Bruce Broussard, and his 2023 earnings of $16.3 million.

“I wouldn’t criticize, but this is so significantly egregiously wrong to deny this claim,” Ross explained. He emphasized that routine cleanings are relatively inexpensive, costing between $80 and $200 depending on the work required. “Standard insurance pays 50% to 80% of the cost for cleanings, but in this case, Humana said they would pay 100%. The work was not extravagant and it’s the core function of what dentists do.”

Ross also highlighted the long-term consequences of neglecting oral hygiene. Without regular cleanings, patients may face costly procedures such as crowns, root canals, veneers, or implants, which can easily run into thousands of dollars.

Rising Trend of Claim Denials

Dr. Ross noted that claim denials from insurance companies are becoming increasingly common, particularly as automated systems take over the claims process. “Sometimes there is no person looking at the x-rays or pictures, and it is programmed to automatically produce denials,” he said.

While acknowledging the complexity of balancing fraud prevention with patient care, Ross questioned whether the current system serves the public good. “What is the balance between the public good and the commercial/profit motive?” he asked.

For the elderly patient at the center of this dispute, the stakes are personal. “He can’t use his hands well, so we just want to help clean his teeth so he can keep them another two, three, four years — it’s very reasonable,” Ross explained.

A Message to the Community

Dr. Ross’s billboard has been up for three months, and he has no plans to remove it until Humana reverses its decision. “Ten thousand people drive by that billboard every day. I won’t take it down until Humana pays the claim for this elderly local man,” he stated.

Interestingly, Ross has no interest in keeping the payment if the claim is approved. “I don’t even want the money. I’ll donate it to Pueblo Community College’s Dental Hygiene program, where I sit on their advisory board,” he said.

The issue has resonated with others in the community. Since erecting the billboard, several patients have approached Ross to share their own frustrations with insurance claim denials. “Stories like this strike a chord across the country. The system is not working very well — the insurance companies deny, delay, confuse — all those tactics and make it so we find it so difficult we give up,” Ross remarked.

Broader Implications

This case reflects growing dissatisfaction with the healthcare insurance system nationwide. “This has reached a boiling point for many of us, patients and providers alike,” Ross said. He referenced recent national events, including the killing of a UnitedHealth CEO, as examples of how deeply these frustrations run. “This is why the Luigi Mangione story is so captivating,” he added.

As the standoff continues, Dr. Ross remains steadfast in his mission to advocate for his patient and shed light on systemic issues within the insurance industry. Whether Humana will reconsider its decision remains to be seen, but the message on the billboard serves as a reminder of the challenges faced by both patients and healthcare providers in navigating the complexities of modern insurance practices.