EXPENSIVE Dental Surgery and Insurance Will Pay Almost Nothing! Ugh!

Updated on August 05, 2011
I.M. asks from Arcadia, CA
21 answers

Hello Ladies,

I don't know if I just feel the need to vent, but I am definitely feeling frustrated! DH never took care of his teeth so now he has to have very expensive dental surgery ($10,000 worth). When the dentist contacted our insurance, they will only pay out $1500 MAX. My husband has a good job and I thought, great insurance. We went to someone who is contracted with the plan. We did not expect them to pay out 100%, but to only pay out 1500 for something that his doctor says is medically necessary and can affect the rest of his health if not taken care of is crazy!

We have a large amount of debt which we have a plan to bring down and we were really starting to make some headway and now this has just blown everything out of the water!. We are even thinking of borrowing against our house or taking out of our 401k's. Which we have done before and swore never to do again, until NOW!

Has anyone else gone through this or something similar? Please no Flames! DH understands that this could have been prevented if he had been more responsible in the past and we can only blame ourselves for the amount of debt that we are in.

Thanks for reading

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P.H.

answers from Dallas on

Is there a Dental College near you? If so, I've heard you can get dental services much cheaper if you go through a dental college/school.

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A.S.

answers from Dallas on

Unfortunately I have never had a dental plan that paid more than that much per calendar year regardless of the amount of work that needed to be done. You also have to ask what portion of that are they actually covering. When they only cover certain things at 50% and 80% there may me more line items they are technically covering. I had to have expensive dental work several years ago and still have some more that needs to be done - Nearly $5000 out of my pocket and that has been over 3 calendar years. Try to work with the dentist on a payment plan, try to find a dental college and see if you qualify. See if you can spread it out. It's tough. We are in debt because of it as well and I have good dental hygiene, just bad genetics.

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J.S.

answers from Chicago on

Would your regular health insurance cover any of the surgery? Worth it to ask.

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J.T.

answers from Dallas on

is there any chance of going through an oral surgeon and having it billed as medical rather than dental? i know our dental insurance has a fairly low annual max payout, but medical is much higher. also, look into care credit, you can usually get a 0% interest for a certain period of time... good luck!

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S.B.

answers from Houston on

You have gotten great advise here. Check with the dentist office and have them review both dental and medical. Some of the procedures could be medically covered thus reducing your bill. Also, get a second opinion. This dentist could be pulling your leg and claiming unneeded work.

Dental insurance is not the same as medical. It generally has a cap. I know its expensive, I have two kids and both needed wisedom teeth out. Both were covered under the medical and not dental. I had a great oral surgeon who understood the system. Good luck!

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J.W.

answers from St. Louis on

Okay, you need to have a sit down with the dentist. $1,500 is the max for most good dental plans. If you don't think so wait till your kids get braces...I digress. That $1,500 is the yearly max so you need to sit down with the dentist and see if what needs to be done can be broken up into more manageable pieces. Yes it will take longer but it is a win win. You will keep getting another $1,500 every year plus you will have a smaller out of pocket that you can hopefully pay by the next procedure.

Okay Gidget brings up another good point to talk with the dentist about. Some parts of dentistry is actually medical. Like when I had my wisdom teeth removed that went to my health insurance not my dental. See if parts can be billed out to your health insurance.

Okay just remembered another thing. There is the company called care credit. We use it for our deadbeats, ya know we give up you just aren't going to pay, we have to finance the finance charges but the collect for us. On the patient side it is free financing up to three years. Find out if your dentist offers it. Oh we use it for our deadbeats only because we have in house collectors, most firms use it for straight up financing.

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B.D.

answers from Pittsburgh on

Your dental insurance might max out at $1,500 in a calendar year. Is there any way that the dentist could do it in sections so that it could be spread out over a few years? Maybe the dentist would be willing to work with you.

Also, is this a dentist that you have a long history with? I've found that unfortunately there are some very shady dentists out there that want to fill things that do not need filled etc. I've also found that some dentists charge a lot more for fillings than others. Could you get a second opinion before you incur this expense that you don't have the funds for?

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J.L.

answers from Minneapolis on

.

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B.G.

answers from Champaign on

Is your dental insurance separate from your health insurance? Ours is, and when our dental refused to pay I called the health insurance. They paid 80%. I would give them a call. It's always seemed strange to me that the two types of insurance are separate, because your dental health is related to your overall health. If your husband does not get this done, it can have a very negative effect on his overall health. Give them a call. After all, what have you got to lose?

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C.O.

answers from Washington DC on

Talk to your dentist and get specifics on why he feels that it's medically necessary and how it will affect his health, etc. You need to get the medical codes that the insurance WILL pay for as well...get your policy out and see what line item specifics it includes or doesn't include...

Get a second opinion as well - you can go in-network - don't tell the next dentist ANYTHING the 1st one said - just go like you are clueless about the situation and see what he/she says and the cost...this way - you will have an unbiased second opinion on what needs to be done...

After all of this? You need to contact both insurance - medical and dental...and get them to ante-up...most insurance companies say NO - then when you fight - or talk back - or however you want to see it - they start to bend...no, it's not easy..but it can be done...

If after all of that - you still can't get them to bend? And the dentist says it is life threatening - then you need to work on making payments to them...many dentists and doctors WILL work with you...

I would STRONGLY suggest NOT borrowing against the house or using your 401K as the taxes on that alone are not worth it.

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J.G.

answers from San Antonio on

A lot of the time, it's $1500 max each year. I dont know if it's a calendar year or a contract year, but you could maybe do $1500 worth of work this year, $1500 worth of work next year ....... Or find a credit card with zero interest for a few years maybe? Girl I dunno. I feel for ya. I forsee a similar problem later for us too. Husband doesn't want to go to the dentist for his annual cleaning and check-up, which are completely free with our insurance. Well in 5 years maybe he'll go and who knows what kind of problems he'll have.

My only other thought would be to go get a second opinion from another dentist.

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N.K.

answers from Philadelphia on

Try to stop thinking about any blame on your husband's tooth care--keeping teeth healthy is a total gamble, that has tons of factors, and our habits are just one aspect--it's genetic, hygiene, diet, bacteria, saliva, sinus, etc. He could have brushed and flossed like a fiend and ended up in the same place, for sure.

If it is cavity-control that got him there, try bringing home some xylitol products (gum, mints, etc.) and also make sure you sanitize all your toothbrushes every couple weeks or so. You can use really watered down bleach for 5 minutes, or listerine for like 15 minutes, etc. You can google it for specifics. He might be more susceptible to the bacteria than you, so you have to do it too, so that you won't reinfect him with kisses. :) Good luck.

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P.R.

answers from New York on

I would not cry over spilled milk. The fact the your insurance does not cover it all when you don't have the funds is sad. You can try to help yourself by taking on another part time job to increase cash income, and try to keep your family on a tighter budget for a little bit until things settle down.

Good Luck!

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H.J.

answers from Minneapolis on

Our dentist will only cover up to 1800 a year in coverage. dental is still considered a luxury by most insurance. If the doctor requested he get the surgery he might be able to get some covered under health insurance especially if the issue is a health risk which it can be sometimes. It never, ever hurts to call an insurance company and say "hypathetically...?"

sry you are going through this. I have big bills coming in the future for dentist so I can kinda feel your pain...:(

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S.B.

answers from Chicago on

I guess I'm lucky that our dental insurance covers $2000/year. I concur with others that suggest seeing if it can be covered by health insurance. Also, do you have a FSA? That is money taken out pre-tax that covers things that insurance won't (like copays, etc). Generally this is done on a calendar year basis - if you set it up during your annual enrollment period, you could qualify for next year. And if you had $5000 taken out for your fsa and needed the whole $5000 in january, they would pay it (even if you had only contributed the minimum amount by then. Of course, you would have to continue to pay it during the year). Can they split it up? Lastly, our dentist has brochures for a special dental credit card that can handle those dental things that aren't covered by insurance. I think it is low/no apr.

hth!

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R.K.

answers from Boston on

If it's medically necessary some of it might be covered under your health insurance call them and find out.

Does he have tonhave it all done at once? Maybe you can split it up and get a payment plan from the dentist.

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S.T.

answers from Kansas City on

if it is a medical nessecity some medical insurances will pay for some of the dental work. not sure if yours will, but it never hurts to ask right??? maybe the dentist will let you pay over time? sorry about your situation, it really sucks!!! most dental insurance barely pays for anything. no wonder so many people cant afford major dental care

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T.D.

answers from Phoenix on

After we put over $5000 on our credit card because of my root canals, we got good dental insurance. It does help with normal cleaning but as far as anything else, it still seems awfully expensive. Ours is also suppose pay $1000 for braces. When we called about my daughter they said we had to wait a year because it was a new policy. But because it was a medical emergency and we couldn't wait a year, we had to go ahead and pay it all. Then two years later we called about my son. They said that because we didn't get them on before his 17th birthday, they wouldn't pay. Geez, thanks a lot! We missed it by two months!! We didn't even know that. We were told it was age 21. Not this policy, apparently...UGH! I'm thankful that our cleanings are free. Otherwise, the insurance is practically useless..

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J.C.

answers from New York on

You need to call the dentis and work out a payment plan that has ZERO interest. If you ask, they will likely do it.

Also, does all of the work have to be done this year? Your average dental plans gave a 1500 per year max. Find out when your olan year begins and see if you can stretch it. In other words, if your lan year starts in January, do some work then (or in December and ask them to submit it in Januay). This way, another 1500 can be used up.

Good luck.

BTW - something funny. I had to have about 3k worth of work right after my wedding. And the dentist said to my husband - you know, when you buy a horse you check it teeth, should have done that with your wife. He thought he was so funny!!! :)

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K.F.

answers from New York on

You may consider postponing the dental surgery if you can for the next year. This is what we had to do with my son who needed some additional dental work past what the insurance would cover for that specific year. Ultimately we only ended up paying out of pocket a fraction of that amount because we just timed it to coincide with the new physical year on the insurance policy.

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L.I.

answers from Dallas on

Oh! I think we have the same insurance! And I think our husbands have twin teeth!!! REALLY!!! I totally feel your pain, have been there over and over, and have a few suggestions. The first may have already been offered to you - I don't know what your credit is like, but there is something out there called Care Credit that is basically a credit card you can apply for - doesn't matter whether its in his name or yours (use whoever has the best credit), and its usually used in places like Dentist offices, Eye Doctors, Veternarians I think sometimes, etc. Not all offices take it though, so first step, I would ask your dentist office if they take Care Credit. If they do, I would apply for it, even if you aren't sure if you would be approved - you never know. If they don't take Care Credit, and you know you have sparking credit, you might consider going to a Dentist who does, especially if your husband has ongoing dental problems - I know how expensive that can get - even with "insurance". If none of that works the next step I would take is to talk to your dentist office and see if they will work out a payment plan with you that doesn't break the bank for you. This is not extremely common, but there are dentists that do it - ours is one of them! If you were in Dallas, TX I would refer you to him! After that the last road we have had to take in the past is the road we least enjoy (that's putting it mildly) - and that is, yes - asking parents for help. We are far past the age we should be having to do that, but if it comes down to feeling a bit ashamed and getting a lecture from the parentals and the health of my husband, I'll pick his health every single time. I hope it works out for you, and tell him to floss :) I'm just kidding - I stay on my hubby and it doesn't matter - I think sometimes its just genetic. Good luck!

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