Dear dental insurance - bite me

[fma_fanatic]

Last month, I somehow cracked a tooth (T#4 for those interested). Going in to see my dentist, he decided the best course of action was a root canal and crown. Simple and easy peasy, right? So he does the work, gives me a temporary sedative filling and has me come back in three weeks (first available slot he had).

I go back today and he does his thing. As he's finishing I notice he's sticking little bits of cotton in and finally lets me know he can't do the root canal. There's a crack somewhere in the tooth where he can't see and blood is oozing. New plan of action - extraction and a bridge. Okay. That works. It's pricey I'm sure, but it works.

So he gets me temporary sedative filling again and I go up to the counter to get the estimated cost. That's when I find out that they won't pay for the two crowns to complete the bridge. Okay. So if they won't pay for the whole thing, just part of the fake tooth, how about a partial. I can deal with a partial.

After about 10 minutes I found out that no, they won't pay for that either (same as above, just part of the fake tooth). So I'm faced with a $2500 bill for the bridge or a $1700 bill for the partial. The ladies in billing said they'd never encountered insurance like this.

I still need to get the extraction, which will probably happen in the next week or so - our receptionist is currently in the hospital being treated for a blood clot and will probably be out the rest of the week.

This sucks and it's making me seriously consider my dental insurance choice for the upcoming open enrollment. I've had this insurance since 2004 and it's good. I guess they don't expect me to chew my food with my molars anymore.

[Kittish]

Is an implant a possibility?

[Geek King]

Make sure you mention to your HR people how the insurance is acting. They usually choose what gets offered, so they may be able to get something better next go around, or even put some pressure on the current insurer.

[Sapphire Silk]

Consider a second opinion with an oral surgeon. He may be able to save the tooth and finish the root canal, and you can avoid the whole bridge thing.

[fma_fanatic]

The insurance won't cover implants. I did finally call them and get more info. Apparently the dental office gave the wrong codes. And they will cover 60%, but not porcelain, metal only. If I want porcelain, I'll have to pay the difference and I know that's about $80 or so.

However, the cost even for a partial is still prohibitively expensive and they won't even consider a temporary unless it were my front teeth. As for the oral surgeon, he was concerned because of the oozing and has agreed with my dentist that the extraction is the best course of action. He was trying to convince me that getting sedation might be good, or even nitrous. I do know I'm having my best friend go with me. She was too tired for me to ask just how squeamish she is, but I imagine if she was with us when we had our cat put down and held her when the vet administered the shot, she'd sit with me. The oral surgeon was okay with that.

[LillFilly]

I agree it may be good to get a 2nd opinion with someone who also takes your insurance; it may not be any cheaper, but they may use different techniques and can work with what you've got.

I had to chose an orthodontist. The first one was adamant he'd have to remove one of my lower molars to get the braces to align my lower teeth. My 2nd opinion believes he can get the teeth to align with only minimal filling of the edges (they're pretty wide). So there I'm avoiding surgery, pain, hospital, etc. Not to mention, neither my braces or the proposed surgery are covered under my insurance (I have good dental, but orthodontics for people over a certain age count as 'cosmetic' treatment.