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So I have been blessed with the wonderful condition known as periodontitis. I've had this as far back as early high school. I've been getting deep cleanings for years and it had done a pretty good job keeping things at bay until some time late last year. Normally, after the cleanings, my gums would be nice and healthy, without any bleeding for a few months, but now we've reached the point where that doesn't appear to help anymore. So my dentist recommended me to a specialist who says I need surgery (osseous surgery, if anyone's curious) because the bacteria that's been infecting my gums has now progressed too deeply under the gum tissue where they have no choice but to cut that open. It also appears that I have quite a bit of bone loss, so the dentist wants to put in bone grafts as well. All of this will cost $10,000, but they say my insurance will cover half that. Since this is the first time in my life that I'll be both getting and paying for a surgery, I'd like to have all my ducks in a row. I don't want any stupid surprise bills or somehow finding out that my insurance won't be covering half of their costs at all or anything. What do I need to do to prepare?
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Jul 6, 2015 00:28
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Mr Interweb posted:So I have been blessed with the wonderful condition known as periodontitis. I've had this as far back as early high school. I've been getting deep cleanings for years and it had done a pretty good job keeping things at bay until some time late last year. Normally, after the cleanings, my gums would be nice and healthy, without any bleeding for a few months, but now we've reached the point where that doesn't appear to help anymore. I would call the insurance company and verify that. Nearly all dental insurances pay out a maximum of $1500 per year (which includes cleanings, x-rays, etc). I had gum graft surgery (twice!) and they paid half ($750 for the first and $1200 for the second) and I paid the other half (with me paying 10% upfront). If your medical insurance is paying for it, it might be a different story.
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Jul 6, 2015 00:54
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If you can try contacting this goon before doing your surgery: http://forums.somethingawful.com/member.php?action=getinfo&userid=27982 He runs a reputable medical tourism company in Thailand. They do dental stuff as well. The standard of care is extremely high in Thai hospitals (which do a lot of the high end dental work) and the healthcare/recovery process is a million times more pleasant. If I were in your situation it'd be the first thing I'd think of. I don't know how insurance would factor into it but it's quite possible that even if your insurance refuses to pay a foreign hospital a dime, and even with flights and hotels, it could be cheaper for you to do it there (plus you get a short vacation). You may also be able to get your work done by someone who only does X all day long anyway, a true specialist in other words, which is generally the best situation to be in for surgery. I've worked in healthcare but not on the billing side of things which most providers know almost nothing about because it's a world unto itself. As far as prep goes I'd bring in a list of current medications, medical problems, and insurance / demographic information -- sometimes anesthesia goes wrong in the dentists office and they ship you to the ER, having that at hand helps the ER should they need it -- it's best not to rely on the dentist's office to have their poo poo together on that even though many do. Do you have someone to take you home afterward and sit with you for a few hours? I would spend some time talking to your own insurance company as well. Relying on the dentist for cost estimates can be risky, though they sometimes have done the same thing with the same insurer before so they do sometimes have a good idea. Still, double check all of that stuff. Because this is a significant expense I would recommend getting a second opinion on the procedure before going head as well. Specialists (usually) make money by doing procedures and therefore are sometimes quicker to recommend them than they should be. When I was in highschool I helped teach judo and kickboxing and one of the kids I taught said he couldn't come in for a month because he was going to get dental surgery. The surgery he was set up for seemed like huge overkill to me given the state of the kid's teeth (not bad at all) and his age (not even through his first growth spurt) so I asked his mom what dentist he was seeing and she said the name of a local dentist who had suggested the same thing for me when I was his age, which I had not done, and had never had an issue because of it. This is a bigger problem with cash practices like dentistry or podiatry or dermatology, in part because greedier practitioners are drawn to these fields and in part because more of their procedures are elective than, say, a heart surgeon, and therefore they get used to selling instead of recommending. I'm not saying your current guy is wrong or not the best guy to do the procedure, he may well be, and if you trust him that's important. But it's at least 5k you're talking, so take a day and ask someone else what they think as well.
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Jul 6, 2015 01:34
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Mister Kingdom posted:I would call the insurance company and verify that. Nearly all dental insurances pay out a maximum of $1500 per year (which includes cleanings, x-rays, etc). How come you had to have gum graft surgery twice? The $1,500 is in fact my own maximum for my insurance as well. Sheep-Goats posted:If you can try contacting this goon before doing your surgery: http://forums.somethingawful.com/member.php?action=getinfo&userid=27982 I actually went to another specialist today and he told me the same thing, that I needed surgery (was not surprised, and wasn't expecting anything else), but before we would begin, he wants to do some scaling and root planing (deep cleaning), which alone would cost $1,000. That would already be bad enough, but the additional problem with that is that I had a deep cleaning 2 months ago and it didn't do anything at all. My gums were still bleeding the very next day, so I don't see what the point of doing that here is. Sounds like he's just trying to bilk more money from me. I also called up my insurance provider again today and got someone who couldn't speak English and they kept saying my plan pays for 90% of my surgery costs, but also only has a $1,500 annual maximum. How can both these things be true? I couldn't understand the guy over the phone so I never got any proper clarification.
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Jul 7, 2015 04:45
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Mr Interweb posted:How come you had to have gum graft surgery twice? The $1,500 is in fact my own maximum for my insurance as well. I have receding gums (hereditary) and I had to have work done around the incisors and then along all of the bottom teeth in the front. quote:I actually went to another specialist today and he told me the same thing, that I needed surgery (was not surprised, and wasn't expecting anything else), but before we would begin, he wants to do some scaling and root planing (deep cleaning), which alone would cost $1,000. That would already be bad enough, but the additional problem with that is that I had a deep cleaning 2 months ago and it didn't do anything at all. My gums were still bleeding the very next day, so I don't see what the point of doing that here is. Sounds like he's just trying to bilk more money from me. Sounds like they did a lovely job. I had that done, too, and had no problems afterward. quote:I also called up my insurance provider again today and got someone who couldn't speak English and they kept saying my plan pays for 90% of my surgery costs, but also only has a $1,500 annual maximum. How can both these things be true? I couldn't understand the guy over the phone so I never got any proper clarification. Where do you get your insurance from? If it's from work, talk to somebody in HR. Most major insurance companies have their call centers in the far east. The CSAs are reading from a script. God forbid you should a question that's not on it. (I do hospital insurance billing for a major hospital and run into this dozens of times a day).
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Jul 7, 2015 12:33
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Mr Interweb posted:I also called up my insurance provider again today and got someone who couldn't speak English and they kept saying my plan pays for 90% of my surgery costs, but also has a $1,500 annual maximum. How can both these things be true? I couldn't understand the guy over the phone so I never got any proper clarification. Keep in mind your insurance will not pay until your deductible has been meet (I don't know what your deductible is). the 90% up to $1500 means exactly what it says.. they will pay 90% of surgery costs up to $1,500. example 1. Your surgery costs $1,666.66. Insurance will cover 90% (assuming deductible has been met) which is $1,500. You pay $166.66 example 2. Your surgery costs $2000. Insurance will cover $1500. You pay $500. exmaple 3. Lets say you have 2 surgeries in 1 insurance year! Surgery 1 costs $1000. Insurance pays $900, you pay $100. Surgery 2 costs another $1000! Insurance pays $600 ($900 + $600 = $1500), you pay $400. NONE OF THESE EXAMPLES INCLUDED YOUR DEDUCTIBLE WHICH YOU HAVE TO PAY BEFORE YOUR INSURANCE SHELLS OUT ANY $$$$. ALSO ALL OF THIS MAY BE INSURED BY YOUR GENERAL HEALTH INSURANCE WHICH WOULD COVER SIGNIFICANTLY MORE $$$$. That is my understanding of insurance. extravadanza fucked around with this message at 12:49 on Jul 7, 2015 |
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Jul 7, 2015 12:47
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extravadanza posted:Keep in mind your insurance will not pay until your deductible has been meet (I don't know what your deductible is). the 90% up to $1500 means exactly what it says.. they will pay 90% of surgery costs up to $1,500. That's pretty much how it goes, but you may or may not have co-pays and co-insurance to deal with as well.
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Jul 7, 2015 16:44
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Mister Kingdom posted:I have receding gums (hereditary) and I had to have work done around the incisors and then along all of the bottom teeth in the front. Ah, well you're not the only one in the unlucky genetics club, amigo. :/ quote:Sounds like they did a lovely job. I had that done, too, and had no problems afterward. I don't think so. My dentist doesn't exactly have the greatest bedside manner, and won't win any awards for best personality, but he's very competent and was very effective and doing a fine job with the cleanings until very recently. The problem as I've been told is that the bacteria spread further down the gumline where deep cleaning can't reach, so even if he cleans the gum line, there's still tons of bacteria and calculus behind it. extravadanza posted:Keep in mind your insurance will not pay until your deductible has been meet (I don't know what your deductible is). the 90% up to $1500 means exactly what it says.. they will pay 90% of surgery costs up to $1,500. Ohhhhh, I see. That makes more sense now. And here I was thinking that they would actually pay 90% of a $10,000 surgery  A friend recommended I try out a dental school for this procedure. I'm in L.A. so I called up USC and they said their rates for osseous surgery are a little under $400 per quadrant. That's a loving huge chunk of savings! Is it a bad idea for me to consider this? Mr Interweb fucked around with this message at 09:55 on Jul 8, 2015 |
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Jul 8, 2015 09:50
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Mr Interweb posted:Ohhhhh, I see. That makes more sense now. And here I was thinking that they would actually pay 90% of a $10,000 surgery I think $1500 max per person on dental insurance is pretty normal, from what my dentist said when I was asking questions about my first fillings earlier this year. I don't know anything about dental school students... but I suspect the quality and time it would take for the procedure would vary greatly depending on how good the student was. I used to get haircuts from an Aveda hair saloon/school. Sometimes it was like any other haircut from greatclips or whatever, but sometimes it took like 2 freaking hours to cut my hair down to 1/2" on the sides, 1" on top.
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Jul 8, 2015 12:33
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