The Teeth! The Teeth!
A while back, I was told I need to get my wisdom teeth out. I do have both dental and medical insurance, but the dental insurance said when I called them to discuss it that wisdom teeth go to medical first and they didn’t generally pay for wisdom teeth removal, and the medical said no way are they paying anything when they were called. So I was a little disheartened by the whole thing, especially since the price for the entire procedure the dentist quoted me was around $1600, give or take a little. Finding this out right on the heels of the $3600 car repair did not do much for my financial state of mind.
So when I had my filling done at the end of February, I talked to the dentist’s billing office about everything, and they seemed to think that they could get the dental insurance to pay for 80% of it, since they are supposed to pay 80% of extractions, and they can bill it in such a way so it should be covered. At any rate, running it through my insurance would give me the discount that the dentist is contracted to give the patients of my insurance. So we filled out a “Predetermination of Benefits” form and sent it off to the insurance company. I was very hopeful, but wasn’t counting any chickens of course.
This week I got the predetermination form back from the insurance, and they are indeed covering 80% of the procedure! It says right on the form the teeth that are being extracted - 01, 16, 17, and 32, so they know it is my wisdom teeth and they are agreeing to cover it. Their negotiated price is $778.00 (gotta love insurance contracts I guess!), and they are paying $622.40 and I will be responsible for $155.60. This doesn’t even bring the total insurance has paid out this year up to my $1000 maximum per year for benefits, so I will still have my cleaning in September covered as well! Hurrah! I couldn’t have gotten better news!
We still have about $300 left in our FSA (which runs from August 1st to July 31st every year for some reason) so I can take the cost of the procedure entirely out of that and still have enough left over for my spouse’s asthma prescription this year. I’ve scheduled the procedure for the first Friday in June at 9am. I plan to sleep most of that weekend knowing we’ve paid for it already, and we didn’t even have to use our economic stimulus check to do it. Again, hurrah!
Life is good.
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March 20th, 2008 at 3:53 pm
I am so sorry about those pesky wisdom teeth! I am STILL waiting on my insurance pre-estimate…and my oral surgeon wasn’t as optimistic as you about how much insurance will cover. =(
I was putting this off as long as possible, but my jaw started hurting about two months ago and I can’t put it off much longer. Thankfully I still have some savings bonds left from my grandmother’s yearly birthday present – I’m going to cash them in and pay for the surgery.
What really chapped my hide about the entire thing was that my old dentist (the one I had for 15 years) NEVER told me I would need these teeth out!! So instead I find out when I am out of school and married, and therefore not under mom and dad’s insurance anymore!
Oh well - C’est la vie, right?
Anyway, good luck with the surgery! I’m still new to the PF Blog scene, but I’ll keep tabs on yours!
- Doris
March 20th, 2008 at 4:16 pm
When I had my wisdom teeth removed, my dental insurance made me run it through my medical insurance first too. I don’t think it is because they won’t pay for it, it’s just in case your medical insurance WILL pay for it. Once the medical insurance denies it, the dental insurance pays it.
Four wisdom teeth, huh? I only had two. You must be super-wise.
March 20th, 2008 at 4:51 pm
I hate it when they try to push it off on the other guy. I think I’m going to have that problem when I have oral surgery in a couple of years. The medical will try to get the dental to pay and vice versa. *sigh*
I got really lucky and only had one mini-wisdom tooth that was removed last fall. It wasn’t too bad, I didn’t even take pain killer after the first day
I hope your experience goes just as well!
March 20th, 2008 at 4:52 pm
ps- I signed up for mysurvey through your link last night. I hope you get your points!
March 20th, 2008 at 5:05 pm
My dentist kept telling me to take out my wisdom teeth and unfortunately I didn’t listen and one day I had this awful headache due to my wisdom teeth.
To make a long story short, I had no dental insurance and had to get my teeth taken out a few days later and I was $1500 poorer
March 20th, 2008 at 5:12 pm
I’m so glad I live in Australia when I read things like this. I’d never have to get things preapproved by my health insurance like this.
March 20th, 2008 at 5:25 pm
I just went through my (second) round of wisdom tooth surgery in August ‘07; don’t forget about anesthetic! It’s generally not covered, although how on earth I’d be expected to stay awake through either set of extractions floors me. The second round wasn’t even an extraction, it was full blown surgery through my sinus cavity to retrieve the rouge tooth growing *up* instead of *down*.
Anyway, they first billed my medical, and they denied. Then they billed my dental, who accepted at the 80%. I eventually get a bill in December for the remaining $240 for anesthetic. *annoyance* I called dental and medical both, and got the same answer; it’s not covered. I was hopping mad, because I had BCBS insurance and MetLife dental.
However, all my followup visits were covered 100%, as well as the emergency visit when I needed to have my stitches redone.
March 20th, 2008 at 6:41 pm
I’m glad to hear you’ve gotten it all worked out!
March 20th, 2008 at 6:43 pm
Fantastic! Preapproval is a great idea, because you really can’t count on the insurance companies to cover you. Good luck with that. Ice cream and such are happy afterwards.
March 20th, 2008 at 7:17 pm
It’s nice that you can find something to be happy about re: getting your wisdom teeth out! You probably won’t feel much like hurrahing on the first day after getting them out I’m afraid. At least knowing you’re not having to pay for it all will make you feel a bit better (^-^)
I second Mrs. Micah on the ice cream.
March 20th, 2008 at 8:02 pm
Awesome on the approval. My husband is having his wisdom teetch pulled in a few months too, luckily with insurance and FSA we won’t be using our stimulus package either! GL
March 20th, 2008 at 8:33 pm
congrats on getting it covered. I had mine out a long time ago, the first day is pretty bad, but it gets better fast. All I can say is you can be happy that once you do it, you never have to do it again! And knowing that it is paid for will make your recovery all the faster!
March 20th, 2008 at 9:44 pm
I find it odd that FSA have a different calendar year, yours start August 1st, mine starts September 1st.
March 21st, 2008 at 12:02 am
Yay! Congratulations! Now you can revamp your plans for that $1600
@Mark - My FSA calendar runs Jan 1 - Dec 31. I’m guessing it’s up to the company? Ours isn’t even tied to the fiscal year.
March 21st, 2008 at 12:34 am
Congrats on getting those pesky teeth covered!!! I’m lucky that I got them extracted while still on my parent’s insurance. I’m saving a ton of money plus I got them out before the roots were totally grown in. This means less pain! First day is tough, but after that it gets better fast. Eat a lot of icecream!
March 21st, 2008 at 8:57 am
Don’t forget to have bags of frozen peas on hand in the freezer for those swollen jaws.
April 8th, 2008 at 8:42 am
I really wish I had gotten off this lucky with my wife’s teeth. The oral surgeon charged $2000, and, being an idiot, it was after she scheduled the appointment that I realized he was out of network.
Anyway, so we had to pay $600 to fulfill our yearly deductible and then we’ll probably be paying $560 more after the insurance paid.
It was so high because out-of-network means they only pay a 60% benefit and my wife insisted on being put under general anethesia. Oh yeah, they were impacted in the most expensive way of course