Insurance Coverage of Root Canals

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Larry R Harrison Jr - 18 Jun 2005 07:05 GMT

My wife apparently needs one. One of her molars on the bottom suddenly lost
a big portion on the top & there's a hole now. She said it appeared
spontaneous, though I've never heard of that happening.

Anyway, I wasn't with her at her appointment where upon physical inspection
(X-rays weren't even needed) they told her it was a goner. She did tell me
what root canals cost, so apparently it can be saved (though she didn't
verify if that's what they said, I wish I had been there to hear it all).

At any rate, as her husband, I'm feeling somewhat inadequate as a provider
as we are nowhere near being able to afford a root canal procedure (which
apparently she could have done to save it). Basically it will have to be
pulled. Yes I know all about teeth shifting--what a bitch of a situation.
Why do teeth have to do that? Why can't we just pull it & be done with it?

But anyway, as I make little money, I'm again feeling inadequate as her
provider (yes, she works too and I don't mind) with having enough insurance
coverage and/or funds to cover this. I'm 36.

My question is simply enough--do most jobs with benefits have plans that
cover such things in full, or are only the absolute best plans (like, say,
the ones for the CEOs or middle managers) the ones that cover such things in
full. I know this is an extremely general question, but I'm wondering if the
typical (say, $25-30K a year) full-time employee with benefits is able to
have such things covered in full, or do most of them still have to pay for
such things out of pocket?

Also--if there is a dental plan which could be purchased by us for coverage
of such procedures, wouldn't it be likely they still wouldn't cover this
because it's a "pre-existing condition?"

Sorry about all the questions, appreciate your help.

LRH

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Vaughn - 18 Jun 2005 12:24 GMT

> Also--if there is a dental plan which could be purchased by us for coverage of
> such procedures, wouldn't it be likely they still wouldn't cover this because
> it's a "pre-existing condition?"

I won't say that it is impossible, but very unlikely. Dental insurance is
not at all like health insurance. Most of them have high co-pays and low annual
limits. Avoid anyone who tries to sell you a dental "plan", every one I have
ever seen is a waste of money.

Remember that your wife will not only need a root canal, that tooth will
also need a crown. FOr about the same amount of money, an implant may be an
option. (ask the dentists here, I am not a dentist)

What I am trying to say is that even if you have an emergency and must pull
an otherwise salvagable tooth, all is not lost. You may be able to set some
money aside while the site heals and get that implant when you can afford it.
Ask.

Vaughn

> Sorry about all the questions, appreciate your help.
>
> LRH

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Mark & Steven Bornfeld - 18 Jun 2005 13:49 GMT

> My wife apparently needs one. One of her molars on the bottom suddenly lost
> a big portion on the top & there's a hole now. She said it appeared
[quoted text clipped - 22 lines]
> have such things covered in full, or do most of them still have to pay for
> such things out of pocket?

    There is no general rule. Some plans pay a fixed dollar amount; some
pay a percentage of a particular fee schedule that the insurance company
(not the dentist) comes up with.
    Of the second type, the most common one in my office covers 100% for
so-called "preventive" services--exams, x-rays, cleanings. "Basic"
services generally (but not always) include fillings, root canals,
extractions, and gum treatment. There is usually a deductible
($25-$100) and then they most commonly cover 80% of their fee schedule
beyond that. Prosthetic services (crowns, bridges, dentures) are
usually covered less--typically at 50%. However, I caution to add that
some plans have no benefits for prosthetic treatment at all. And this
is where you are most likely to find exclusions for pre-existing
conditions--ie: there may be no benefit for replacing teeth lost before
the effective date of coverage.
    If you or your wife are offered dental insurance through your jobs, you
should discuss it (especially if you have to select a particular plan)
with your benefits manager or (even better) your dentist to understand
what all the legalistic jibberish means in the real world.

Steve

> Also--if there is a dental plan which could be purchased by us for coverage
> of such procedures, wouldn't it be likely they still wouldn't cover this
[quoted text clipped - 3 lines]
>
> LRH

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

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W_B - 20 Jun 2005 16:09 GMT

>Why do teeth have to do that? Why can't we just pull it & be done with it?

Ask the OEM.

Can't help with your other questions.
--

W_B
Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com

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clifffreeling@yahoo.com - 21 Jun 2005 20:55 GMT

> My wife apparently needs one. One of her molars on the bottom suddenly lost
> a big portion on the top & there's a hole now. She said it appeared
[quoted text clipped - 10 lines]
> pulled. Yes I know all about teeth shifting--what a bitch of a situation.
> Why do teeth have to do that? Why can't we just pull it & be done with it?

I faced this situation a month ago, i.e. spend over two grand on one
tooth,
or have it extracted for $149. I chose the extraction without any
hesitation.
It seemed an easy decision for me. So what if there's a little
shifting?
I had a molar pulled many years ago and the small bit of shifting has
made
virtually no difference in my life, dental or otherwise. The main
reason
I wanted the extraction was that I just wanted the damn tooth OUT, end
of story...no root canal, crowns, extra dental visits, etc. But
coincidentally, I had a permanent crown installed less than six hours
ago
(on another tooth).

Hopefully, no more dental visits for the next 30 years. As it stands
now,
I have 28 teeth (never had a full set for some reason, but did just
fine),
two teeth with fillings (today, and one 3 weeks ago), and a new crown,
first for me.

> But anyway, as I make little money, I'm again feeling inadequate as her
> provider (yes, she works too and I don't mind) with having enough insurance
[quoted text clipped - 7 lines]
> have such things covered in full, or do most of them still have to pay for
> such things out of pocket?

My wife's insurance (at her place of employment) is the insurance I
used.
*All* employees at her company have this if they choose. They paid
100% for
my initial visit, with x-rays, exam, etc. Then they paid almost 80%
for
the fillings (after $50 deductible), 60% for the crown, etc. The total
for my recent work was just over $2k, with me paying less than $750 of
the total, the rest was picked up by the insurance, which was a help.
Our dental coverage has a yearly limit of $2,000 however, and doesn't
cover things like implants, etc., but I'd never be interested in that
anyway.

> Also--if there is a dental plan which could be purchased by us for coverage
> of such procedures, wouldn't it be likely they still wouldn't cover this
> because it's a "pre-existing condition?"

Good question, and it has occurred to me also. I can only say that
while I can
imagine some unsavory insurers maybe trying something like this, that
wasn't
the case with us, and we only started this plan last summer. If you or
your don't have access to a good dental plan at either of your jobs,
I'd
do some real checking before I signed up for one on my own. They may
be
real happy taking your premiums, but, let us say, niggardly, when it
comes
to honoring claims. Ask around. Good luck.

--
Cliff

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