Insurance is a joke. I had surgery this week...We pay for good insurance Delta Dental

[greenbriar]

I had a wisdom tooth that appeared after many years. It was bad and the roots were wrapped around another tooth.

I went to my dentist Feb 16 and he couldn't pull it ... had to be done at oral surgeons.

no problem right...we have insurance



We had to pay 456 dollars because "insurance" wouldn't pay for anestheia for a "simple extraction"


simple ...if it were simple the dentist could have done it

simple... if it were simple,I wouldn't have 8 stitches in my mouth


grrrrrrrrrrr

so for a procedure that cost 712.00 dollars, we had to pay 456.00 bucks

that is AFTER we pay monthly premiums for coverage.


heck we could have saved money by not paying for the dental part and just paying for the whole procedure out of pocket

[Maat]

1. My family's (Hubby, Daughter and I) are in the same boat.

The dental coverage is of limited utility.

[leftstreet]

2. But think of all the Claims Denial Specialists you're employing!

It's insane, isn't it.

:grr:

[greenbriar]

6. the business lady seems to think we will get a refund

because the "simple extraction" required stitches and that changes things.


I hope so


I am thankful we had the money in savings. I realize not everyone does

[Liberal_in_LA]

29. Don't EVEN think about getting braces unless you are prepared to sell your car.

[Maat]

3. Hubby, Daughter and I are in the same boat.

Our coverage is fairly useless.

[sandnsea]

4. Well fight that

I get your frustration and you're right and it happens in a hundred different ways - but you do have to fight this one. You have to fight it for all the people who don't know how, because this was not a simple extraction for all the reasons you stated. They get away with it because not enough people fight back.

[proud2BlibKansan]

5. "Why Dental Insurance Isn't Really Insurance"

My dentist has this pamphlet in his waiting room. Always makes me chuckle.

[Gabi Hayes]

35. oops....that's what I have....nochoice--through school district

never had anything but checkups, but I have a WT that needs to come out.

supposed to be routine, but who knows

their coverage is fine if you don't need it, basically

[proud2BlibKansan]

37. Until a few years ago, my school district dental plan didn't pay for root canals

So when I needed a root canal, I had the tooth pulled instead. It was 1/10 the cost to have an extraction. Then I had a bridge put in, and most of the cost for that was covered by the insurance. I told my dentist if I needed another root canal I would do the same thing. He just shook his head. LOL

[dana_b]

7. I'm sorry. Delta Dental isn't that great

my kid had to have two wisdom teeth pulled. No complications but her mouth is too small to hold them. So we had to pay half of it. It was $2000. Ugh! A $1000 bill was no fun.

Now i just found out from the dentist that Delta cut more benefits. We are allowed to free cleanings a year but onl one exam. If the dentist examines our teeth on that second cleaning, we must pay for it.

Hope your mouth is feeling alright!

[greenbriar]

8. thanks...I had a rough time of it

but last night I was able to eat some small slices of deli ham and boy it tasted soooo good.

This morning, I am really sore again and almost nausiated...pain meds I think...


but over all, it is better

[imdjh]

13. codeine makes me nauseated.

Not to mention that the prescribed amount doesn't do the trick, and enough to actually kill the pain makes me stupid. There are, of course, better pain killers out there but the doctors won't prescribe them. I despise having someone I am paying tell me what he is and isn't going to do. I despise having to ask for a drug that works because my doctor is afraid it will rel tag him or something. Mostly, I despise the government "protecting" me in this way.

Dammit, if I am in pain I want demerol, and enough demerol .

[marmar]

9. My insurance company (it remain nameless, but is a 5-letter word that begins and ends with "A").....

...... is actually good for dental, but very marginal when it comes to medical coverage.

[hedgehog]

10. Dental insurance is the neglected step child of health insurance.

Mine only covers about half of my bill for everything from wisdom tooth extraction to normal cleaning. Part of the problem may be that dentists are in a seller's market. My family doctor thinks dentists charge way more per hour than primary care physicians. I do have to say that dentists are drifting into the same area as dermatologists and plastic surgeons. They all can make more money for unnecessary cosmetic procedures than for basic health care. It's very frustrating to live in a town with lots of young people with bad teeth while the dentist has advertisements all over his office for whitening procedures and other cosmetic fixes.

[Triana]

11. that's what I do - I don't pay for dental insurance - it only covers

cleanings, x-rays, some basic stuff. Hell, I can pay for that myself.

When you get into oral surgery - the REALLY EXPENSIVE STUFF that people need help with the MOST? FORGET IT - dental insurance doesn't cover much of it and then - there's a "lifetime maximum" that is reached PDQ with oral surgery - after you've reached that - the dental insurance won't pay another dime for such procedures ever again for you.

AND THIS IS AFTER YOU'VE PAID THEIR GODDAMNED PREMIUMS FOR YEARS. They're making a FORTUNE off those premiums and won't pay for jack crap when you most need it. Forget it.

I a NOT buying into that racket.

I end up paying out of pocket - luckily the oral surgeon let me split my bill into payments over 4-5 months. Sheesh.

[Critters2]

12. But it's better than a government program, where some bureaucrat

would be making health care decisions, right? :sarcasm:

[NNN0LHI]

14. Lesson learned. Dentists aren't qualified to pull teeth

They don't have the training, experience, technique, etc. to do the job properly.

That is what oral surgeons are for.

Sometimes trying to save a buck or two doesn't pay at all.

Don

[PCIntern]

19. Oh Really...?

I've been doing this 32 years, thousands of extractions, a handful of post-op issues dring that time, and I'm not an oral surgeon.

I was an instructor for many years at a dental school and although oral surgeons are trained for extensive dental procedures, I would bet that a conscientious, experienced GP dentist can do as good a job, if not in many cases, better in the matters of routine, non-impaction exodontia .

BTW, I also have been an expert witness in surgical cases as performed by GP's and know what I'm talking about....

[JanMichael]

24. I sure wish you were in NC

I need a crown replaced this year, and a root canal. I have no fear of dentists, love going...but, it sure would be nice to give money to a good Democrat.

[LostinVA]

28. I may have a name for you

I need to see if they're still practicing. Female, close to where you live there, and was a Dem -- at least 10 years ago.

[NNN0LHI]

27. Having one dentists knee in my chest was enough for me to figure it out

Same tooth after the unsuccessful try was pulled with no pain, pressure or knee in the chest by a dental surgeon who knew what he was doing.

In a pinch I could pull a tooth too. That doesn't make me qualified to do it either.

Not knocking your trade I just think people should stick to doing what they were mainly trained to do. I have a great dentist. Very pleased with his work. But I wouldn't let him pull one of my teeth. Or do a root canal either. That is a job for a doctor who practices Endodontics for the same reasons I listed above. The chance of the root canal being done right goes way up having the right person do the job from my own personal experience.

Don

[dysfunctional press]

45. yes, that one lousy dentist you encountered is evidence against the whole profession...

:eyes:

[uppityperson]

40. Maybe you should do a traveling dental clinic for DUers.

I'd sign up when you were out here in WA.

[kentuck]

15. If truth be known...

There is probably some type of collusion between the dentists and the insurance companies. For example, if the full cost of the procedure is closer to $456 dollars than $712.00, then the insurance companies will pay very little of of their treasure chest. Their "contracts" with the different dentists could pay whatever they agreed upon - not necessarily the $712....I have thought this for some time and believe it should be investigated.

[Cleita]

16. And this is what the insurance company shills who are now in the Obama

administration want to bring to the nation. They also want to strip us of our Medicare and other government health programs to allow the insurance companies to take over.

[blues90]

17. when I had dental insurance through my job

At first it was Guardian which was within the dentists group so the dentist could only charge what they said he could charge and the work I had done was almost completely covered . Then where I worked went to GE select and I paid full price actually most of the cost. They didn't cover anything other than check ups and 40% to 50% of any procedure.

When I lost my job I found out my employer was not paying any of the dental at all.

I had exrays done and the dentist said they could do root canals and when they found one root was decayed on each of three molars I was charged for the high cost of the attempt of the root canal and then oral surgury to remove the three molars so I paid twice , one would think an exray would show these decayed roots.

[CrispyQ]

18. About 10 years ago I had the most unbelievable dental insurance!

I was with this company for 2 years & used up every penney I could of coverage. I had all of my 30 year old fillings replaced, I had some oral surgery, I had a crown & I was fitted for bleaching trays. I think I paid $150 a year for all of that! I'm on Delta now, & I'm looking at another crown & I will have to pay about 40% of it which will be just under $600. I console myself that my $7 monthly premium is still cheaper than the 60% they picked up. ~sigh

Wouldn't an extraction that had to be done by an oral surgeon be categorized under something different? Like surgery?

Good luck.

[otohara]

20. I Was Scheduled For Breast Biopsy

The day before the appointment, I get a call saying what my insurance will pay and my portion is $650.00 for a needle biopsy. My portion is as much as the insurance company.

Stupid me, I thought because mammograms were paid in full as a preventative measure, a small biopsy procedure would also be paid in full.

I'm not too worried about it, it's so frickin tiny what they saw and it most likely is nothing, but right now, we don't have the money.

Then I find out that my Democratic state representative introduced and got passed a bill that was supposed to benefit small business insurance. Something about healthy vs unhealthy employees - the benefit was our co-payments went up quite a bit.

I wonder how many women like me have had to put off or say no to biopsies because the co-pay is so damned much.

[LibDemAlways]

21. The yearly coverage limit on our Delta Dental policy

is $2000.00 per person. My daughter's orthodontist recommended that she have her wisdom teeth removed. The bill will be a whopping $2900.00. There goes her entire coverage for the year, and we'll still be out over a grand plus the cost of routine cleanings, exams, and any fillings or anything else that comes up.

Her ortho bill was $5300.00. Delta paid $2000.00, so we were out $3300.00 for that. Memo to Delta - Orthodontia is expensive. Two grand doesn't begin to cut it.

Between deductibles, premiums, and policy limits, Delta Dental is a joke.

[valerief]

22. Insurance companies are legalized extortion. nt

[Clear Blue Sky]

23. Dental insurance sucks. It can hardly be called insurance.

[glinda]

25. You are lucky actually

I need 30 thou in oral surgery and our Dental Insurance that we paid THOUSANDS into for years only would cover 1000. Now I sit without surgery, without work and we dropped our stupid Dental Plan because all they did was steal our money. We were actually treated pretty crappy by them on the phone also.

[LostinVA]

26. Run it through your medical insurance -- it should pay for oral surgery

As Outpatient. Mine always has for oral surgery ("simple extraction," wisdom teeth,etc.). You'll probably have to pay about $75-200m depending on the insurance.

And, as an aside, Delta is NOT a good dental insurance company.

[uppityperson]

39. I agree with this also. Med insurance should pay for oral surgery.

They will probably pay more than DD does also. I ran the #s on DD and got it last yr for 1 1/2 yrs. It ended up costing me less for my one root canal and crown, but am going to drop it soon.

[Fire1]

30. It's a joke alright and it's on us. It's also a huge racket.

[pansypoo53219]

31. modern insurance is a ripoff

i think maybe we should TIGHTEN oversight and make them squeal like the pigs they are.

[DeepBlueC]

32. You can win an appeal, I think

It's not a simple extraction;it's oral surgery. You can prove it. Ask the oral surgeon for a letter (he'll know what to say & in your case an x-ray will be good evidence) call your own benefits department (I don't know about yours but mine has intervened to approve an exception allowing anaesthesia for all my dental work) first and/or then the insurance company and ask for a supervisor, say you want a review of that decision & you have supporting materials.

Bastids. :grr:

[Medusa]

33. I had to have some hospital tests last month--I owe 2K

in medical bills, WITH insurance.

[mzteris]

34. talk to the oral surgeon's office

about recoding it. Maybe someone coded it as a "simple extraction" and that's all the insurance company has to go off of.

[Grinchie]

36. I ran into the same thing, I pay out of pocket now.

Truly, most of us are born with great gene's. We have survived half a century with only the occasional illness. We are taught to trust doctors, take their medicines, and everything will be right as rain. They don't tell you that the Human body, like any other organism creates lots of waste. This waste needs to be flushed out, along with all the other dead cells that created that wasted and then died, as is the natural cycle of life. We shed trillions of used up, work out cells a day, along with waste products that they produced.

This process goes along fine, but in many instances, the mechanisms can be overloaded. We introduce chemicals and compounds into out body that must be removed. This can be voluntary or involutary. Large amounts of alcohol, or 3 big macs are voluntary, but they still need to be processed and excreted.

Some are involuntary, like Sodium Fluoride, Smog, or that sickly scent they put into Clorox or laundry Detergent. These compounds never existed in nature, and are so stable they can survive a load of laundry in Hot water, and then varorize and spew that same scent all over the neighborhood, and into your lungs.

The human body is a machine that has finite limitations. It has autonomous systems that are slow to react, process waste products slowly and steadily. We need to allow the body time to do its work, and take care not to overload it with too much crap.

This is the secret to remaining healthy. Maintaining a relatively clean system that is not struggling to keep up with the ever increasing load of waste, chemicals, metals or other compounds.

This is why GMO is such a serious threat to our ecology. BT Corn i.e. Monsanto Mon-810 contains Bacillus Thuringensis toxin (CR1A and others) in every cell of the plant. There is no escaping this fact. When humans ingest this toxin, you may not get terribly ill, but it is a toxin nonetheless. Over the years, your body, intestines and the microbes we depend on in their to help us digest food will be dealing with this added load of toxins. Don't even tell me that one would die of old age before it would affect you, but thats wrong. When I did of old age, I want to be healthy, not dying of renal failure because 30 years of eating GMO corn has destroyed my waste removal mechanisms.

We have been bombarded with Alien chemicals for the past 50 years, and we are seeing it in cancer rates, obesity, stupidity, diabetes, etc. The science for all of these chemicals was developed in the 1860's, and still operates on principles discovered back then. Testing for these chemicals has only become efficiant in the last ten years. The dirty little secrets of toxic overload are now strating to be understood, and a wait and see attitude, using people as guinea pigs is now bearing fruit -- they are dying not of old age, but do to system collapse.

A good example of toxic overload and a healing crisis are the workers at the 9/11 site. These people were allowed to work without dust masks. This is absolutely criminal. EPA even went so far to say that there was nothing to fear in the air. Yet we see items like this Nationwide 9/11 Responder Health Program Still Not Up and Running dated 9/8/2008.

Being exposed to Nuclear Radiation is Safe. DDT is safe, watch me eat some. RoundUp is safe, watch me drink some. Nutri-Sweet (Aspartame - Where did the Nutri come from) is safe, watch men, women, children and hospital patients drink it. Flouride is safe, lets put it in the municipal water supply, watch EVERYONE drink it. Methylated Lead is good for your car, and Safe! Smoking is refreshing! Everyone deserves to own a car. Coal plants are clean! Chloramine is safe!

No people, we are surrounded by an ever increasing load of crap that we need to process and expel. When we drink municipal and most bottled water, you are getting another dose. When you breathe the air while stuck in rush hour traffic, just think of all the engines churning away, competeing for the oxygen you need to survive, burning it up, and mixing it with hydrocarbons before it pumps it back out for you to breathe. Think about all the plastic off gassing chemicals into your air conditioned passenger compartment.

When you get home, you can relax in from of a TV that is off-gassing plast fumes cause they made it in China where they don't get the plastic quite stable. Sitting on the carpet that is releasing formaldehyde. This is a small subset. And people wonder why they get ill.

The truth is that our bodies have millions of bacteria living in it all the time. We can only keep them from overwhelming the system if we don't overwhelm it in other ways, via pollution, bad dieat or stress.

Allopathic medicine is popular because it makes lots of money, but it is false. You have the ability to control your health the majority of the time, not the doctors.

[uppityperson]

38. File an appeal. They are one of those who automatically deny things 1st filing.

There are insurance co's who do that and I think DD is one of them. Speaking from experience. I had an abscess, went to my dentist, referred to (endodontist?). They refused to pay him since it was "an appointment for the same tooth within 30 days". I appealed, wrote a letter and called explaining the situation (of COURSE it was within 30 D since it was an emergency referral) and the paid.

So, file an appeal with them, don't just pay if they deny you. Get a letter/report from your dentist and the oral surgeon and send those to DD.

I hate insurance co's like that, but they are out there. Good luck.

[Xithras]

41. Yep, I was about to say the same thing. I've had this experience with DD

Had my impacted wisdomn teeth taken out about 8 years ago. The teeth were rotated downward and putting pressure on nerves that controlled part of my facial muscles, so the dentist wouldn't touch it. The oral surgeon actually went through the gums, drilled through the side of the bone, and removed the teeth in pieces to prevent facial paralysis.

Delta Dental turned a big chunk of the bill down (including anaesthesia) because they thought it was excessive for a simple extraction.

We filed an appeal, the dentist and surgeon forwarded their records showing why the procedure was done, and Delta paid the bill without any additional trouble.

Delta Dental rejects these bills as a matter of course, knowing that most people will simply accept it. As long as your dentist can document the need for the procedure, they will pay it on appeal.

[uppityperson]

42. Insurance companies like this are there to make money. Not to help but make money

They do that by collecting premiums and denying payments. If even a small portion of their "customers" give up and just pay, they make money.

Always appeal. As a health care provider, I have given people reports to file with other type insurance companies. Getting a report/documentation from a provider is part of the insurance "game".

Don't give up, appeal. It is part of the process. It sucks that we have to do this.

[hfojvt]

43. I find Delta Dental to be excellent

but always wonder what that flower is they have on.
A faded rose from days gone by?

I pay about $14 a month, and they just paid for a check up for about $90 and will pay for my four fillings for about $200. Heck, I don't know how they make any money. They don't off of me. Of course, my employer pays about $14 a month too. So they may make a little bit of money this year, if I don't have more trouble.

[paulsby]

44. it depends.

for example, the insurance i have through my employer is GREAT.

seriously.

it's also very "wired". i can look up everything online. i go to a dr, chiro, massage, whatever, and that is on the web in a few days, with a detailed breakdown of payments, etc.

it really is excellent.

some insurance SUCKS.

[flyarm]

46. Turn your insurance paper over and write on it you demand an appeal

and have the dentist /oral surgeon do the same thing..fight it..they count on you just paying it and going away.

In Sept they thought I had melanoma on my lips..3 sections had to be cut out of my lips..I was not going to allow a dermatologist to do it..I had a plastic surgeon do it..its my face dang it..it was full blown surgery..and my insurance company was doing the same shit...they also refused to pay for the anestheia, and the plastic surgeon..the doctor said bull and he appealed it 5 times..and the insurance company finally paid it almost all in full.

The Plastic surgeon said they are all playing this game now..hoping you will pay it ..appeal it. and keep appealing it.

( oh I was very very lucky mine wasn't c , but there is no other way with the lips to know, but to remove it all..I had 3 big dark spots ..it was horrible but it wasn't the big "c" so it made it alot, lot easier to deal with all the stitches in my lips.. afterwards!!)

[Kansas Wyatt]

47. Insurance companies deserve NO seat at the table, with regards to health care reform.

Insurance Companies are life sucking parasites that contribute NOTHING to health care.

The White House and Congress needs to seriously consider whether they really want Death Merchants to have a seat at the table, considering these same Death Merchants, along with Pharmaceutical Companies, is the reason why this country has a health care crisis today. They had their chance to make good on their assurances that they could ethically conduct themselves appropriately in health care, but they chose to maximize profits while minimizing responsibility.

Oh ya! Could someone in the medical profession explain to me why in the Hell teeth and eyes are not included with medical care? What's next... Ear-care coverage?
It's not like teeth and eyes are fucking accessories at birth. They only damn reason why it is not included with medical coverage, is so Insurance Companies can screw more money out of people.

[FlyingSquirrel]

48. Here's a question..

Did the oral surgeon explain all your anesthesia options and whether they were covered by insurance in advance?

When I had my wisdom teeth pulled, they just said, "...and we're recommending general anesthesia..." and moved on to the next topic.

So I filed a complaint with the attorney general's office about it when I found out how much I was gonna have to pay.

The oral surgeon decided to simply remove the charge for anesthesia rather than have to deal with the complaint.

Just a thought.