Crappy insurance for crappy teeth!
June 21, 2010 2:02 PM Subscribe
Should I pay out-of-pocket to have my broken molar/filling looked at now, or wait for however long it takes to get an appointment through my asshole dental HMO?
I've been under a bunch of stress lately, and I tend to grind my teeth a bit. The end result of this is that, on the way to church yesterday, a good-sized piece of what could have been either tooth or composite filling broke off from one of my molars. This molar has been a crappy, chalk-like tooth since the day it grew, pretty much, and a couple years ago a huge amount of it, together with an old amalgam filling, got drilled away and replaced with composite filling. The broken place doesn't hurt -- yet -- but it kind of throbs a bit, and it feels mildly unpleasant if I poke it with my tongue or put ice on it. It's obvious to me that this thing is going to start actually hurting pretty soon.
I attempted to call the primary care dentist on my insurance card (back story: I'm kind of overdue to get my teeth cleaned. Last time I got them cleaned, I had a bit more money and different insurance, so I got to go to the good dentist who I like. Now, I have a different insurance plan. My old dentist wasn't covered, so they randomly assigned me a different dentist.) This dentist is only open on Wednesdays (WTF?), and has no emergency number (double WTF?)
Today, I called my insurer and explained that I had a dental emergency and couldn't get ahold of my dentist. The woman on the phone at the dental insurance place first accused me of lying about the lack of an emergency number, then called the dentist herself and confirmed that there was no emergency number, and finally said that I would either have to wait until Wednesday to speak to the primary dentist, or pay out-of-pocket at a different dentist. She flat-out refused to reassign me to a dentist who is actually open on more than one day of the week.
At this point, I don't really know what to do. I'm afraid that if I wait until Wednesday to call this random dentist office, the dentist won't have any time to see me even to evaluate the tooth for weeks (if they're only open on Wednesdays, they must be booked up for like a year in advance), I'm not going to get an appointment to have it fixed until God knows when, and my teeth will all fall out of my head like that Monty Python animation. On the other hand, it costs a shitload of money to get your teeth fixed without insurance, so I would have to borrow money from my parents again (given that I have about $20 in my bank account). This would be kind of a shitty thing to do to my parents, especially given that I don't know exactly how much money it's going to take to fix my face, and that I know it will cost at least $100 for the initial office visit.
If I actually somehow manage to make a dental appointment in a way that is covered by my dental insurance, it will be significantly cheaper. An evaluation and/or cleaning would be free, a replacement filling has a <$100 copay, and a root canal has a $350 copay, so even if I end up needing a root canal, I could sell some of my stuff to get my tooth fixed without borrowing money from my parents.
Thoughts about what I should do? Brilliant solutions? Options I didn't know I had?
I've been under a bunch of stress lately, and I tend to grind my teeth a bit. The end result of this is that, on the way to church yesterday, a good-sized piece of what could have been either tooth or composite filling broke off from one of my molars. This molar has been a crappy, chalk-like tooth since the day it grew, pretty much, and a couple years ago a huge amount of it, together with an old amalgam filling, got drilled away and replaced with composite filling. The broken place doesn't hurt -- yet -- but it kind of throbs a bit, and it feels mildly unpleasant if I poke it with my tongue or put ice on it. It's obvious to me that this thing is going to start actually hurting pretty soon.
I attempted to call the primary care dentist on my insurance card (back story: I'm kind of overdue to get my teeth cleaned. Last time I got them cleaned, I had a bit more money and different insurance, so I got to go to the good dentist who I like. Now, I have a different insurance plan. My old dentist wasn't covered, so they randomly assigned me a different dentist.) This dentist is only open on Wednesdays (WTF?), and has no emergency number (double WTF?)
Today, I called my insurer and explained that I had a dental emergency and couldn't get ahold of my dentist. The woman on the phone at the dental insurance place first accused me of lying about the lack of an emergency number, then called the dentist herself and confirmed that there was no emergency number, and finally said that I would either have to wait until Wednesday to speak to the primary dentist, or pay out-of-pocket at a different dentist. She flat-out refused to reassign me to a dentist who is actually open on more than one day of the week.
At this point, I don't really know what to do. I'm afraid that if I wait until Wednesday to call this random dentist office, the dentist won't have any time to see me even to evaluate the tooth for weeks (if they're only open on Wednesdays, they must be booked up for like a year in advance), I'm not going to get an appointment to have it fixed until God knows when, and my teeth will all fall out of my head like that Monty Python animation. On the other hand, it costs a shitload of money to get your teeth fixed without insurance, so I would have to borrow money from my parents again (given that I have about $20 in my bank account). This would be kind of a shitty thing to do to my parents, especially given that I don't know exactly how much money it's going to take to fix my face, and that I know it will cost at least $100 for the initial office visit.
If I actually somehow manage to make a dental appointment in a way that is covered by my dental insurance, it will be significantly cheaper. An evaluation and/or cleaning would be free, a replacement filling has a <$100 copay, and a root canal has a $350 copay, so even if I end up needing a root canal, I could sell some of my stuff to get my tooth fixed without borrowing money from my parents.
Thoughts about what I should do? Brilliant solutions? Options I didn't know I had?
I forgot to add, definitely ask your parents for a short term loan if it's possible at all.
posted by anniecat at 2:29 PM on June 21, 2010
posted by anniecat at 2:29 PM on June 21, 2010
FWIW I lost a filling in an otherwise stable tooth years ago and have ignored it. Every couple of months I have to take an Advil because it gets a little tender. It actually got less sensitive as time went on.
My point is that there's no harm in waiting to see what Dr Wednesday's office has to say when they open.
posted by DarlingBri at 2:40 PM on June 21, 2010
My point is that there's no harm in waiting to see what Dr Wednesday's office has to say when they open.
posted by DarlingBri at 2:40 PM on June 21, 2010
Best answer: I had a back molar filling crumble out of my head (cracked by a bad dentist a year previously). I kept the gap very clean, gargled with salt water if it ever felt odd, and finally got it fixed a decade later, no problems.
So you can avoid infection, but there is the problem of how much of the tooth will remain to be worked on if you have to wait too long, as it's now weak and might crack and crumble more - you can wait 'til wednesday but you might lose more tooth. On the other hand, it's a molar and less visible so a gap might not be the end of the world.
Nthing dental schools - we have an excellent dental school doing practical work out of the primary hospital in my city. The students are supervised and generally do fair work for little money. Emergencies are more interesting for them than standard care so you might be in luck.
posted by L'Estrange Fruit at 2:48 PM on June 21, 2010
So you can avoid infection, but there is the problem of how much of the tooth will remain to be worked on if you have to wait too long, as it's now weak and might crack and crumble more - you can wait 'til wednesday but you might lose more tooth. On the other hand, it's a molar and less visible so a gap might not be the end of the world.
Nthing dental schools - we have an excellent dental school doing practical work out of the primary hospital in my city. The students are supervised and generally do fair work for little money. Emergencies are more interesting for them than standard care so you might be in luck.
posted by L'Estrange Fruit at 2:48 PM on June 21, 2010
I second the "wait as long as you need to" advice. Keep it clean, and you should be fine...
posted by Holly at 3:15 PM on June 21, 2010
posted by Holly at 3:15 PM on June 21, 2010
Best answer: You should be ok to wait till Wednesday. It doesn't sound like the pain is paralyzing, but do take L'Estrange Fruit's advice on preventing infection. Call first thing in the morning on Wednesday and stress that you have a dental emergency. Play up the physical pain if need be. My dentist is typically booked solid for months but will always get people in the same day if it's an emergency.
If they won't see you on Wednesday, then you have to look at your alternatives. One thing you might want to try is calling the insurance company back and talking to someone different about changing your primary dentist. The reaction you got - being accused of lying - is really bizarre and I wonder if it was just your bad luck to get someone unprofessional on the phone. If the new person can't help you, go up the food chain (ie, ask for supervisors) until you find someone who can.
I find it difficult to believe you can't change your primary at all - what happens if your primary retires? Or does a bad job? For whatever reason, they might want to make it difficult to change your primary, but there's got to be some way of doing it.
Finally, if this doesn't work, could you talk to HR (if your insurance is through work) and ask them to call the insurance company for you? Sometimes this works, because the insurance company wants to keep institutional clients happy.
One more thing: advil is great for tooth pain, because it is an anti-inflammatory. Use slightly more than the recommended dosage if necessary (assuming you don't have any allergies).
posted by lunasol at 3:25 PM on June 21, 2010
If they won't see you on Wednesday, then you have to look at your alternatives. One thing you might want to try is calling the insurance company back and talking to someone different about changing your primary dentist. The reaction you got - being accused of lying - is really bizarre and I wonder if it was just your bad luck to get someone unprofessional on the phone. If the new person can't help you, go up the food chain (ie, ask for supervisors) until you find someone who can.
I find it difficult to believe you can't change your primary at all - what happens if your primary retires? Or does a bad job? For whatever reason, they might want to make it difficult to change your primary, but there's got to be some way of doing it.
Finally, if this doesn't work, could you talk to HR (if your insurance is through work) and ask them to call the insurance company for you? Sometimes this works, because the insurance company wants to keep institutional clients happy.
One more thing: advil is great for tooth pain, because it is an anti-inflammatory. Use slightly more than the recommended dosage if necessary (assuming you don't have any allergies).
posted by lunasol at 3:25 PM on June 21, 2010
When my molar crumbled I thought it was a huge emergency. None of the dentists I called tried to get me in
quickly. I did not have insurance at that time. I had no pain, and the office at the dentist I ended up going to said to put wax over it, if my tongue or cheek was bothered. It took a week to get in to see the dentist, and then another week for my root canal appointment. I had never had this problem before and was surprised how it didn't seem urgent to any dentist. Also, I made my appointment with an office who would had a payment plan that was not a line of credit. So, I paid for the exam right away, a little over 100$ and then the "work up" prep for the root canal I was able to pay over two months. Call the hmo dentist, and try to get in with them, and call around for info to others in the area, while you wait. Then you'll be ready to make a decision if your pain increases or the HMO dentist doesn't work out.
posted by Swisstine at 3:26 PM on June 21, 2010
quickly. I did not have insurance at that time. I had no pain, and the office at the dentist I ended up going to said to put wax over it, if my tongue or cheek was bothered. It took a week to get in to see the dentist, and then another week for my root canal appointment. I had never had this problem before and was surprised how it didn't seem urgent to any dentist. Also, I made my appointment with an office who would had a payment plan that was not a line of credit. So, I paid for the exam right away, a little over 100$ and then the "work up" prep for the root canal I was able to pay over two months. Call the hmo dentist, and try to get in with them, and call around for info to others in the area, while you wait. Then you'll be ready to make a decision if your pain increases or the HMO dentist doesn't work out.
posted by Swisstine at 3:26 PM on June 21, 2010
Oh, and (of course!) one more thing: a long time ago, I had a molar crack, and lost a piece of the tooth, along with a filling. I ignored it for months, because I was young, dumb, broke and deathly afraid of dentists.
I finally went in 7 months later (not proud of this!) when I was experiencing some serious pain. I had to get a root canal, and it would have been so, so much better if I'd gone in earlier. But at the same time, the outcome wasn't catastrophic, just expensive and uncomfortable. So: don't wait as long as I did, but also don't panic if you can't get this taken care of tomorrow.
posted by lunasol at 3:31 PM on June 21, 2010
I finally went in 7 months later (not proud of this!) when I was experiencing some serious pain. I had to get a root canal, and it would have been so, so much better if I'd gone in earlier. But at the same time, the outcome wasn't catastrophic, just expensive and uncomfortable. So: don't wait as long as I did, but also don't panic if you can't get this taken care of tomorrow.
posted by lunasol at 3:31 PM on June 21, 2010
Now. -someone who had to have a tooth pulled because the dentist misdiagnosed a cracked tooth.
posted by ishotjr at 3:48 PM on June 21, 2010
posted by ishotjr at 3:48 PM on June 21, 2010
The dental school I go to charges less than your copay. And they have emergency walk in appointments about 3 days a week, I believe. If you happen to be in Houston, it's the UT Dental Clinic.
posted by MexicanYenta at 4:19 PM on June 21, 2010
posted by MexicanYenta at 4:19 PM on June 21, 2010
Do call back your dental insurance and find out about their process for changing dentists. It may not be something you can do before Wednesday (lovely HMO red tape!) but you should still be able to get a list of names to choose from in your area so you can look into switching, in case you would like to get a dentist appointment on any day other than Wednesday in the future!
posted by platinum at 1:29 AM on June 22, 2010
posted by platinum at 1:29 AM on June 22, 2010
Response by poster: Update: I discovered that there are multiple offices with the same name as the primary care dentist, so I called all of them in turn until I found one that had an actual human picking up the phone. Turns out that it's one dentist with five different offices in five different sketchy neighborhoods of the city, so I might be able to get in there sometime this week.
I fully intend on switching dentists after this, because everything about the series of interactions I've had with this dentist has led me to believe that this is some kind of weird fly-by-night operation. The dental school at my university is supposed to be pretty good, they do payment plans, and I think my insurance covers them, so I'll most likely switch to them. Unfortunately, you need to schedule emergency care with them in the early morning, so hopefully if I haven't gotten the stupid tooth looked at by today, I can get in there early tomorrow and set up an appointment. Then I'll swing over to the Benefits office and file a complaint against the dental insurance people for being obstructive and rude. This frigging tooth started to really throb last night and I didn't get much sleep, so I'm in a vindictive mood.
posted by kataclysm at 7:00 AM on June 22, 2010 [1 favorite]
I fully intend on switching dentists after this, because everything about the series of interactions I've had with this dentist has led me to believe that this is some kind of weird fly-by-night operation. The dental school at my university is supposed to be pretty good, they do payment plans, and I think my insurance covers them, so I'll most likely switch to them. Unfortunately, you need to schedule emergency care with them in the early morning, so hopefully if I haven't gotten the stupid tooth looked at by today, I can get in there early tomorrow and set up an appointment. Then I'll swing over to the Benefits office and file a complaint against the dental insurance people for being obstructive and rude. This frigging tooth started to really throb last night and I didn't get much sleep, so I'm in a vindictive mood.
posted by kataclysm at 7:00 AM on June 22, 2010 [1 favorite]
Response by poster: Update Part Deux: I was supposed to be able to get in and see Sketchy Dentist at some point this week, but they offered me an appointment that I could not take without access to both a teleporter and a time machine. The next "emergency" appointment they could offer me was so far in the future that I might qualify for the senior meal at Denny's before then. I am 26.
I then had epic wranglings with the insurance company (lasting an hour and a half, 30 minutes of which was spent on hold) in which I made them switch my primary care dentist to the dental school at the university. The dental school has first-come, first-served emergency appointments five days a week. I intend on camping out in front of the dental school obscenely early tomorrow morning (but no matter what, they should be able to see me by the day after tomorrow).
posted by kataclysm at 11:25 AM on June 22, 2010
I then had epic wranglings with the insurance company (lasting an hour and a half, 30 minutes of which was spent on hold) in which I made them switch my primary care dentist to the dental school at the university. The dental school has first-come, first-served emergency appointments five days a week. I intend on camping out in front of the dental school obscenely early tomorrow morning (but no matter what, they should be able to see me by the day after tomorrow).
posted by kataclysm at 11:25 AM on June 22, 2010
Yay dental schools!
posted by L'Estrange Fruit at 3:43 PM on June 22, 2010
posted by L'Estrange Fruit at 3:43 PM on June 22, 2010
This thread is closed to new comments.
posted by anniecat at 2:28 PM on June 21, 2010 [1 favorite]