• The insurance company Humana denied the routine teeth cleaning claim of a Pueblo West man.
• The dentist who performed the cleaning is fighting back with a scathing digital billboard message.
• The dentist says insurance companies denying claims appears to be happening more often, "especially as the claim processing system is becoming more automated."

What started off as a routine cleaning for an elderly man who has trouble using his hands has turned into a Colorado dentist publicly denouncing a "significantly egregious" wrong perpetrated by the insurance company that has refused to pay.

Dr. Taylor Ross of Pueblo West Neighborhood Dental and Implants has worked in the community for eight years and has spent more than three decades in the profession.

When an 83-year-old patient came to him in December for a cleaning, Ross and his staff realized the man was struggling to clean his teeth properly.

"So we took pictures of his teeth and then cleaned them. Pretty routine, right? Humana, the patient's dental insurance, promised to cover this cost completely as part of his policy," Ross told the Chieftain.

So when Humana denied the claim based on the company's finding of "no evidence" for the cleaning, Ross decided to fight back. He has posted the "no evidence" pictures on the digital billboard outside his office adjacent to U.S. Highway 50, along with the name of Humana's CEO Bruce Bossard and Bossard's 2023 earnings of $16.3 million.

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"I wouldn't criticize, but this is so significantly egregiously wrong to deny this claim. Cleanings are very small ticket items that range between $80 and $200 depending on the extent of work that is done," he explained.

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"Standard insurance pays 50% to 80% of the cost for cleanings, but in this case, Humana said they would pay 100%," Ross said. "The work was not extravagant and it's the core function of what dentists do."

By contrast, those who don't get regular cleanings can face the need for crowns, root canals, veneers or implants that "will be in the four digits pretty easily — costing thousands and thousands of dollars," he said.

Dentist says claim denials are happening more often

Claim denials from insurance companies are happening more and more, Ross said, "especially as the claim processing system is becoming more automated."

"Sometimes there is no person looking at the x-rays or pictures and it is programmed to automatically produce denials," he said.

"I understand the need to guard against fraud and the system is complex, but there is a confluence of very different needs. What is the balance between the public good and the commercial/profit motive?"

Ross said the system is not working for this particular patient and there are patients like him "in all of our communities."

"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.

Why Ross is sharing the story

"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," Ross said.

The sign is in the third month of putting Humana on blast.

"Here's the thing, 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.

"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 explained.

Since putting up the billboard, a few patients have asked Ross about it and several have voiced how frustrating it has been dealing with dental and medical insurance claims.

"This has reached a boiling point for many of us, patients and providers alike. We've seen this reverberate across the country since the killing of the UnitedHealth CEO and this is why the Luigi Mangione story is so captivating," Ross said.

Chieftain reporter Tracy Harmon covers business news in Colorado. She can be reached by email at [email protected] or via X at x.com/tracywumps. Support local news, subscribe to The Pueblo Chieftain atsubscribe.chieftain.com.