Insurance won't cover GA, now what? - Mothering Forums

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#1 of 7 Old 06-02-2010, 02:46 PM - Thread Starter
 
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My DD is 2 and two different dentists have said that she needs about 6 cavities filled, including a crown. The 2nd dentist said it would take about 3 hours over 3 visits doing conscious sedation and it would be much safer to do GA.

My medical insurance won't cover the anesthesia for any dental procedure and the dentist won't even consider doing it w/out coverage because she says it's too expensive to pay out of pocket. Conscious sedation just doesn't seem like a safe option to me considering the amount of work, my child weighs a lot (so the dentist is saying she won't be as "out of it") and DD screamed just having her mouth looked at.

Any thoughts, insights or wisdom would be greatly appreciated!

Thanks,
Bree

Mom to my sweet girls Lily (3/14/05) and Miriam (7/10/08) , wife to Scott.
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#2 of 7 Old 06-03-2010, 03:42 AM
 
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We are in the same boat...kind of.

Our insurance would pay - in theory - for the GA related hospital costs (not for the dentist, but for the GA), BUT:
We have a 10,000$ deductible, of which we had met 0 $ before the surgery. So that means, they won't pay after all.

If it helps, I can give you an overview of our costs:

Dentist's estimate BEFORE the surgery 2800$ (that's what I had to pay before he'd do the procedure)

Hospital estimate 6000$ (surgery was last Friday, so I haven't received the final bill yet)

Dentist 2nd bill AFTER the surgery 1300$ (he said he did a bunch of xrays and there were more fillings than anticipated )

And there'll be a bill from the anesthesiologist at the hospital.

We are asking the hospital to put us on a payment plan, paid the first dentist bill with a credit card and are currently trying to figure out how to pay the second

There's a health care credit card from GE, called Care Credit, that often doesn't charge interest when you pay the amount off within the agreed upon timeframe (usually 12 months for amounts over 1000$). You might want to look into that and ask whether your dentist accepts it. Just make sure you pay it off before the promotional period expires, because they'll charge interest (a lot, like 20some %) retroactively if you don't.

Also go back and double check your medical insurance regulations....we do not have dental coverage, but our insurance would cover GA for dental procedures if the child is under 7 years (provided the deductible had been met). Maybe you have a clause like that as well?

As you can see we opted for the GA as well. I didn't feel comfortable with the conscious sedation option, either. And from what you describe, your DD would probably have a hard time with it.

If you can manage the payment at all, I would definitely choose GA.

Good luck
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#3 of 7 Old 06-03-2010, 12:21 PM - Thread Starter
 
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Thanks for the info, it was really helpful. I'm getting a copy of our insurance contract today and go from there. Did you explore buying supplemental insurance?

Mom to my sweet girls Lily (3/14/05) and Miriam (7/10/08) , wife to Scott.
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#4 of 7 Old 06-03-2010, 05:32 PM
 
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Quote:
Originally Posted by BreezyMom View Post
Did you explore buying supplemental insurance?
No, I didn't....mainly because I wasn't aware that there is something like it (I'm not from the USA originally and apparently still have a lot to learn about the health care system )

Coincidentally, I read in a magazine today, that there are "dental discount plans" that would pay some of the bill and don't have a long waiting period after you sign up with them.....I don't know whether you meant something like that, if not, that might be another avenue to explore
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#5 of 7 Old 06-05-2010, 03:30 PM - Thread Starter
 
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Just to let you know, I talked to my insurance agent, and buying supplemental insurance is not an option, so you didn't miss anything.

Mom to my sweet girls Lily (3/14/05) and Miriam (7/10/08) , wife to Scott.
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#6 of 7 Old 06-07-2010, 02:56 AM
 
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Thanks....that makes me feel a bit better

We're still trying to find a way to pay for the second dentist bill. We do have a Care Credit Card, and every other doctor's office I've encountered up to now participated in their regular promotions (i.e. they give you 3 months to pay off if bill is at least 300$, but 12 months if bill is more than 1000$), but this dentist only lets you have the three months...not very helpful
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#7 of 7 Old 06-07-2010, 07:11 AM
 
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Have you considered a second opinion?

1st dentist DS saw (at a year) had us come up for 3 twenty minute appointments as DS got used to her. She just billed once. She was awesome, but wasn't a ped dentist and just wasn't sure about what drugs she might need to give him.

2nd dentist...well, we walked out of there laughing at his prognosis. First, he wanted to diagnose his problems based on DH's and my weight problems. Hadn't even looked in DS's mouth and was talking about juice and sugars and all of that. Judged me for letting DH take over when it was time to look in DS's mouth, which I did for DS, because we found in the 3 short appointments that he is much "better" for his dad than for me. Then he found cavities ALL over, had to fill ALL of them. One big cavity in front, probably needed to just yank out FOUR teeth, because the cavity was behind two and the whole reason for the early visits was that two of his upper teeth grew in yellow, turned brown, and were disintegrating (as did some of hubby's baby teeth, as did all of my FIL's baby teeth).

He wanted us to get an MD and nurse from the hospital, do GA in the office coordinate with our medical insurance.... We left and didn't go back.

Found another ped dentist recommended by a MDC person (yay!), he filled the cavity behind the two front teeth with NOTHING. Took the two awful teeth out with just a blip of lidocaine. And he's been watching the "spots" (that the other guy said HAD to be filled). For 4 years now. They haven't changed, haven't gotten bad, haven't done a thing.


So I'd get another opinion.

And perhaps start with someone who will break the appointments up, who will start with nothing and work up IF it's needed. That's DS's dentist's policy. Start off with nothing (OK he does have TVs in the ceiling and he runs Disney movies on them). Move up to lidocaine. etc etc etc. Parent is ALWAYS invited into the work room, and in fact DS's first visit and his filling visit were accomplished with DS's hips and legs on DH's lap, and DS's torso and head on the dentists's lap. By the third visit, DS ran back there and jumped up onto the chair, ready for his few minutes of movie and whatever the dentist had to do!

Can't recommend finding someone like that more.
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