Friday, November 21, 2008

Making the Most Out of My Dental Benefits

Since I am threatened with the loss of employment in January, I am trying to make the most of my health care benefits while I still can. Last week I discovered I had already maxed out my vision care benefits until January. And today, since I already had to go to the dentist, I decided to investigate my dental benefits as well.

First of all, I am lucky to have dental benefits in the first place. According to the American Dental Association, only about half of the U.S. population is covered by a private dental benefit plan. But even those that are covered, in my experience and research, still face hefty out of pocket costs if they require complex care. My father, for instance, has yet to replace a temporary crown in his mouth because it costs about the same as a slightly used car to replace.

Back when I had to have my dental surgery, I looked up my benefits to make sure I would not incur any out of pocket costs - that I frankly couldn't afford. And I was pleased to learn I had a maximum annual benefit of $1800 a year. The surgery was billed to me at $1100 (I nearly had a heart attack when I opened that) but I think it was negotiated by my insurance company at a lower rate.

It was not until today, however, that I discovered my unionized counterparts in State government have an annual benefit of $2300. WTF? And job security, wow, if only I could join their ranks.

Judging from the amount of cavities I've had filled this year (3), my two cleanings and my surgery I predict I have just about used up my entire $1800. Which is good for me since I got all these issues addressed and didn't need to spend more than $25 - the deductible I still haven't gotten around to paying - but bad for my wisdom teeth. They need to come out.

I've known for a good six months or so that my wisdom teeth were impacted. All four of them. I am not experiencing any pain with them but my dentist told me if I leave them in it will start to shift my other teeth and they will be hard to clean when I age. I know I can't afford to take them out now and hope I can either wait a little longer to have the surgery or keep my job. Ideally both.

I asked my dentist whether or not he thinks the oral surgeon could run the procedure through my health insurance instead of my dental - an all too common bit of administrative trickery - and he was uncertain. His coworker overheard the question and was a little more honest - that it would be up to the oral surgeon (aka he'd have to exaggerate on the forms a bit). I don't want to be considered a liar or a cheat but does it make sense to you that the same surgery is covered by one piece of paper but not the other? What would you do?


Shtinkykat said...

Sallie, you're too freaky to write about your wisdom teeth! I just got one of mine extracted yesterday!

If I were you, go to the oral surgeon (which will cost you a co-pay) and ask the oral surgeon to get a pre-approval from your health insurance. If he's unwilling to do that, you'll know your answer. If he's willing to do it, then you'll know whether your health insurance would cover it too. Good luck!

Anonymous said...

ewwww man, yeah taking out wisdom teeth is no fun - but i agree, you DEF should do it sooner than later!

i was told for 10 years i need them out, but just brushed it off....i'll be fine i thought....until one day 1 of the 4 came up out of nowhere and was like "BAM, here i am sir!" haha...

i sucked it up and had each and every one extracted within the week - and now, no more worries!

Sunflowers said...

I had all 4 of mine taken out a couple months ago. 3 were impacted. I ended up paying about $500, with insurance. (they would only take my dental. And I agree with you, it doesn't make sense)

It really can't hurt you to wait. Mine had been impacted and (very very slowly) shifting my teeth for years. I finally got them removed because I was getting braces. Take a look at this site before you decide one way or the other:

Unknown said...

Having regular check up of your dental health is must.but for this you have one good dentist too.
Reno Dentist