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Medical Forum / General / Dentistry / September 2005Impossible Dentures ?
TARGET / GOAL : Dentures: upper and lower, mini implant retained : $4,000.00 total. Insurance MetLife max for year : $2,000.00 (seem to pay about 50% of everything if dentist is in network ) $ 2,00.00 each ( Upper, lower. IE : I pay $1,000.00 each, MetLife $1,000.00 each . Or I pay $2,000.00 total, MetLife $2,000.00 total. ) ____________________________________ 1. ) Cost for extractions : 5 upper, 10 bottom, anesthesia , etc ? ____________________________________ 2. ) Upper denture ( what's minimum cost for reasoable appearance ? ) Lower denture ( what's minimum cost for reasonable appearance ? ) Temporary ? then the " real " ? or reline ? ( if Mini Implants, does that change the need for two sets ? ) _______________________________________ 3. ) Costs MINI IMPLANTS : on lower , 2 ? or 4? or 6? On upper : any benefit: phonetic, stability, smaller palate ? _______________________________________ 4. ) What are other costs ? Ie : What does the dentist, lab charge ? ________________________________________ 5. ) How would it get done : Dentist " in network " , dental school , travel ; Costa Rica, Canada ? _________________________________________ I"m in lower Ny state, Westchester County, Yorktown, about an hour north of Manhattan. Have posted a few times regarding this under " voicelit " . Marty ( voicelit ) > TARGET / GOAL : Dentures: upper and lower, mini implant retained : > $4,000.00 total. [quoted text clipped - 40 lines] > > Marty ( voicelit ) $2000 for two dentures is reasonable (not counting "temporaries"). I don't know the going rate for mini implants. Personally, I'd opt for more conventional implants, unless the minis are intended for temporary use. Unless your intent is to make a full palate unnecessary, I'd put two implants in the lower and use "O" ring retainers for the lowest-cost retainer, and use a conventional non-implant retained FU denture. Low-end for a pretty standard Centerpulse fixture implanted is about $1200. here in Brooklyn, so placing two is $2400 or more right there. The extra lab work and such on the denture would be up to about $500. You could also use some kind of clip-bar device, but this would be significantly more expensive. I've got a friend in Yorktown--unfortunately he's a psychiatrist, not a dentist. ;-) Steve  Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > TARGET / GOAL : Dentures: upper and lower, mini implant retained : > $4,000.00 total. [quoted text clipped - 4 lines] > $ 2,00.00 each ( Upper, lower. IE : I pay $1,000.00 each, MetLife > $1,000.00 each . Or I pay $2,000.00 total, MetLife $2,000.00 total. ) Assuming that $4,000 is impossible, and noting that you are really talking about a string of procedures here, timing may be very important to minimizing your out-of-pocket cost. When does your "insurance year" start/end? Also, does your employer have one of those plans where you can set aside pre-tax money for medical expenses? Vaughn Good points. Will find out when insurance year begins and ends. Idea being : getting a total of $4,000.00 out of them. Any idea of how aware of that cute move the insurance companies are ? What they can and would do about it ? Problem seems to be that, at the low end where the dentists are in network, they're not very interested in dealing with ANYTHING. I get the impression they try to awe an uneducated clientele, very huckstery, don't think they even really want my business - I'm not fawning enough. Funny, my wife and I had a great consult with a big name implant dentist in Connecticut: Koos. He was really interested in his work and made us a great offer that was still a little too much for us; but he mused as to how maybe splitting the work over two years might help us. You tend to get that relaxed, adult conversation with the higher end docs. Steve, the Minis would be because they are much cheaper and the denture can be placed immediatly. Alot of people are using them to stabilize / retain especially lower dentures. What's a ".... non-implant retained FU denture... " ? We're actually in Mohegan Lake ( or Shrub Oak . It's actually a controvery . ) a hamlet of Yorktown. Strange place; a working class, blue collar part of Westchester County. Never saw so many auto body etc shops. We were just living in New Canaan Ct. ( don't ask ) a land of designer humvees, now it's all Ford f 150 pick ups. Marty ( voicelit ) > Good points. Will find out when insurance year begins and ends. Idea > being : getting a total of $4,000.00 out of them. [quoted text clipped - 21 lines] > > Marty ( voicelit ) A bit of culture shock. I drove back from my brother-in-law in eastern Mass., and did part of the trip on 22. I think I heard that some areas are claimed by Pleasantville and Scarsdale. I know the minis claim they can be loaded immediately. I don't know of long-term statistics yet--maybe someone else can comment. By non-implant-retained, I mean a standard full upper denture. Most folks do fine with full uppers, unless they are uncontrollable gaggers. Lower dentures are where you really need the retention and stability of dentures. Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > ________________________________________ > > 5. ) How would it get done : > Dentist " in network " , > dental school , travel ; Costa Rica, Canada ? > _________________________________________ I'm Kaannadian, and so I can tell you that IMO, unless you have relatives you can stay with for an extended period of time, the cost of travelling will not engender a savings. Roy Brown may chime in on this, but I also don't think you'll find that dental work, especially implants, are significantly cheaper here in Kanada. JMO SP SignatureTake out the TRASH to reply $4000 USD is about $6000 CDN. Should be able to get a couple of implants on the lower here with dentures for about that. If they went to the dental school (U of Toronto), they would pay about 50% of that, with the insurance forms completed. I'd think they could do that in the US for about the same somewhere. SignatureRoy rem NADA to reply | > ________________________________________ | > [quoted text clipped - 11 lines] | JMO | SP > $4000 USD is about $6000 CDN. Should be able to get a couple of implants > on the lower here with dentures for about that. If they went to the dental > school (U of Toronto), they would pay about 50% of that, with the > insurance forms completed. I'd think they could do that in the US for > about the same somewhere. Thanks for that, Roy. But the point is: is he really saving anything by coming up here, renting a room, travelling, etc... Thanks SP SignatureTake out the TRASH to reply I just read the 45 page document about the guy who went to Tiajuana Mexico for his dental crowns ...... from Falp's site ........ its very interesting. On some page near the bottom, it is revealed that the guy set up some business to lure Americans to Mexico for Dental?vaca vacations ...... VERY FUNNY! Its a huge AD. There are comments from disinterested parties who I am betting are all the same guy too! Joel >> $4000 USD is about $6000 CDN. Should be able to get a couple of implants >> on the lower here with dentures for about that. If they went to the dental [quoted text clipped - 6 lines] >Thanks >SP | > $4000 USD is about $6000 CDN. Should be able to get a couple of implants | > on the lower here with dentures for about that. If they went to the dental [quoted text clipped - 6 lines] | Thanks | SP Wouldn't think so unless they were close to the border. IIRC the individual was in the NE USA, if so, it might be worth checking into prices in Maine. (certain economical factors might provide for lower fees there). Tx. might be combined with vacations. SignatureRoy rem NADA to reply marty here ( voicelit ) original poster this thread. MetLife tells me that I can't just bring up my benefits on the wesite with are numbers , passwords , etc. They have a number you call, give them your info, and they pull up your benefits. A recent phone call to them revealed that they infact do cover implants. Here's the thing though : not where a tooth has been missing for awhile ( that would be " pre existing " ) only where a tooth had to be extracted. Hadn't heard of the only one denture per every five years idea. Many things they tell you must be submitted first by the dentist for eview and pre approval. Marty > marty here ( voicelit ) original poster this thread. MetLife tells > me that I can't just bring up my benefits on the wesite with are [quoted text clipped - 8 lines] > > Marty Don't take the 5-year frequency limitation for granted. It is in fact the industry default. However, I've very occasionally heard of 3 year frequency limitations on prosthetics. In most states you need not submit treatment plans for authorization. Mostly it is for "pre-estimate". The ins. companies state that this is to eliminate "misunderstanding" about your benefits, but in fact any dental office worth its salt will be able to figure out what is covered and what is not. The more cynical dentists feel pre-estimates exist solely to slow down the process of payment. An exception to pre-estimates being optional are benefits through some union welfare funds. Some of these are administered by insurance companies (for example, the UFT in New York is administered by Cigna), but here we have a true "pre-authorization", not a "pre-estimate" and if the treatment hasn't been pre-authorized the claim will not be paid. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > In most states you need not submit treatment plans for authorization. > Mostly it is for "pre-estimate". The ins. companies state that this is > to eliminate "misunderstanding" about your benefits, but in fact any > dental office worth its salt will be able to figure out what is covered > and what is not. The more cynical dentists feel pre-estimates exist > solely to slow down the process of payment. How can we figure out what is covered and what the percent coverage will be if we can't see it written in black and white what his benefits are? Not trying to be picky here, but I don't see how I could figure that out without the list of procedures and prices. Thanks SP SignatureTake out the TRASH to reply | > In most states you need not submit treatment plans for authorization. | > Mostly it is for "pre-estimate". The ins. companies state that this is [quoted text clipped - 11 lines] | Thanks | SP Even with the lists, one does not know how much the patient has already used for the year. SignatureRoy rem NADA to reply > "Stovepipe" <stove99pipe@yahoo.ca> wrote in message > | Not trying to be picky here, but I don't see how I could figure that out [quoted text clipped - 5 lines] > Even with the lists, one does not know how much the patient has already > used for the year. That is also true. Thanks SP SignatureTake out the TRASH to reply How do you post an image ? Marty >How do you post an image ? > >Marty Tape it to the window, snap with digital camera, then upload to www.tinypic.com. Then post the reference to the image here. Its also best to reduce the file size, say myphoto.bmp might be 1 Meg while saving the same identical file in Paint, on a Windoze computer as Myphoto2.jpg will reduce the file to 70-80 Kb. That's a savings of 90%. JPG is a compression format. Joel What's a good size for this forum ? You can actually read an x-ray that's been photo'd like that : tape to window, digital camera , etc ? Then how do I post image to this site: somehow post link to tinypic ? Is the TinyPic site free ? Marty > What's a good size for this forum ? You can actually read an x-ray > that's been photo'd like that : tape to window, digital camera , etc ? > Then how do I post image to this site: somehow post link to tinypic ? > Is the TinyPic site free ? > > Marty Try it out with photos you already have on your computer. It is easy and free. You go to www.tinypic.com and click on host it or something like that. They ask you to browse your computer and you click on the photo you want to upload. It says posted with success or whatnot and you scroll down to the bottom of the page. You will see links that you can highlight and copy and paste into your message. It doesn't get any easier than that. Cheers SP SignatureTake out the TRASH to reply | > What's a good size for this forum ? You can actually read an x-ray | > that's been photo'd like that : tape to window, digital camera , etc ? [quoted text clipped - 13 lines] | Cheers | SP I just tried posting an example for you. Here is an x-ray that is about 4 times the size of a pan. I don't remember if I used a window or a fluorescent ceiling light behind the x-ray, and took a shot with my 5 megapixel digital camera. It is a shot of my canine's implants (keeping it dental related without dental x-rays available) . The original file size is 1.05MB or 1,107,407 bytes (2592X1952 pixels). Tinypic scaled it down to 203,917 bytes (1944 x 1464 pixels) http://tinypic.com/dmp307.jpg This should give You some idea of what is possible. SignatureRoy rem NADA to reply Okay, will try tomorrow when sun's up. Just finished painting the upstairs bathroom window which is located IN the shower. Gonna get the whole 2nd floor replaced next spring anyway but the window was just to decrepid for my wife. New house, newly bought / house is old. Got the tub drain working in 1st floor bathroom ; had to re-invent the whole drain plug rig. Have successfully found and printed out our fireplace insert whatever. Have not yet installed the invisable electric fence for our wild pup. Marty [..] >is a shot of my canine's implants (keeping it dental related without dental >x-rays available) . The original file size is 1.05MB or 1,107,407 bytes >(2592X1952 pixels). Tinypic scaled it down to 203,917 bytes (1944 x 1464 pixels) >http://tinypic.com/dmp307.jpg > >This should give You some idea of what is possible. REPLY Fascinating shot .... I had no idea they did breast implants on dogs ........ > ....and took a shot with my 5 megapixel digital camera. It is a shot of my > canine's implants (keeping it dental related without dental x-rays [quoted text clipped - 3 lines] > > This should give You some idea of what is possible. Gotta admit: that is quite impressive; with both legs done like that. Cheers SP SignatureTake out the TRASH to reply Good points: the amount of the $2,000.00 yearly cap getting eaten up with each consult. AND... if any dental work being done on my wife is comes out of my or our cap. I'll have to find time to go back at this insurance ( MetLife ) thing again tomorrow. Like I said, in a first stab at getting to the bottom of all this , following all their steps, I found that you must phone them for specifics about one's benefits. Then, you have to interview , grill, cross examine the representative . Last go 'round, I was able to get beyond my wife's impression that they never would cover an implant as it would be a pre existing condition. I uncovered that that only refered to where a tooth was already missing not at the site of an extraction. It might be cheaper for me to hire a lawyer, threaten lawsuit and see if I can't get them to settle out of court for a full set of real not mini implants and horseshoe overdentures. Marty > It might be cheaper for me to hire a lawyer, threaten > lawsuit and see if I can't get them to settle out of court for a full > set of real not mini implants and horseshoe overdentures. > > Marty IMO, one thing the insurance industry does have is lots and lots of lawyers. They'll keep it going round and round 'till the BMW'S are paid for on both sides of the litigation. SP SignatureTake out the TRASH to reply >What's a good size for this forum ? You can actually read an x-ray >that's been photo'd like that : tape to window, digital camera , etc ? > Then how do I post image to this site: somehow post link to tinypic ? >Is the TinyPic site free ? > >Marty TinyPic is free. the link might look like http://www.tinypic.com/45367fed.jpg DO NOT CLICK, I just made that up! (I clicked just to make sure its not something ......) Joel > | > In most states you need not submit treatment plans for authorization. > | > Mostly it is for "pre-estimate". The ins. companies state that this is [quoted text clipped - 14 lines] > Even with the lists, one does not know how much the patient has already used for > the year. Here one must use pre-estimates very carefully. I have more than once had a situation where I sent in a pre-estimate while other claims were pending (sometimes my own claims, sometimes the claims of others--specialists or even other gps that the patient may have seen without my knowledge). Filing a claim with the assumption that you know the patient's remaining benefits for the year is more than a little risky--esp. if you are expecting assignment of benefits. Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } Aftrer Roy suggested: > > Even with the lists, one does not know how much the patient has already > > used for the year. [quoted text clipped - 8 lines] > > Steve This brings up an important point: The estimates we give our patients should include a statement that reminds them to take into account any other evaluations they may have asked for in the relevant time period and also those of any other family member included in the policy. Thanks SP SignatureTake out the TRASH to reply Steve, what a great website. I lived for years in the urban pioneering area of Brooklyn in the '80s . Boerum Hill 'tween the Heights and Park Slope. I get the impression from reading the faqs on your site that you're not real up on the stuff ( suposedly ) going on with the mini implants ? All kinds of stuff on the DentalTown Imtec Mini Forum . The " immediate Load " was for a case in which they are retaining a full denture not the sole support of some kind of overdenture. I have a panarama type x-ray I could post for everyone. Just don't have a scanner. How would I digitalize something like that ? Marty | Steve, | [quoted text clipped - 11 lines] | | Marty Hold it up to a window or fluorescent light and take a digital picture of it. SignatureRoy rem NADA to reply > Steve, > > what a great website. I lived for years in the urban pioneering > area of Brooklyn in the '80s . Boerum Hill 'tween the Heights and Park > Slope. There's no more pioneers there--just very expensive apartments and houses. I'm in Windsor Terrace--I live in a condo that was used as the bank building for the movie "Dog Day Afternoon". My wife lived on Dean and Bond before she moved in with me. We still get our coffee at D'Amico's on Court St. > I get the impression from reading the faqs on your site that you're > not real up on the stuff ( suposedly ) going on with the mini implants > ? All kinds of stuff on the DentalTown Imtec Mini > Forum . The " immediate Load " was for a case in which they are > retaining a full denture not the sole support of some kind of > overdenture. I always assume some tissue support for anything I'm calling an overdenture. I'm not saying they won't be fine. But you're right--I haven't used them, and most of the more cautious surgeons I'm working with are shying away from them for now too. I'm just a little hesitant, both with the immediate exposure and esp. the immediate loading. That may be because I remember the bad old days where an implant often meant a blade implant that was exposed and loaded immediately, usually with poor results. These may well turn out better. Steve > I have a panarama type x-ray I could post for everyone. Just don't > have a scanner. How would I digitalize something like that ? > > Marty Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > TARGET / GOAL : Dentures: upper and lower, mini implant retained : > $4,000.00 total. [quoted text clipped - 40 lines] > > Marty ( voicelit ) Marty: there are a multitude of problems, MOST IMPORTANTLY that MET LIFE will in no way shape or form pay for any sort of implant. Read your MET contract. I happen to be a metlife provider in New York City [Manhaten] and do alot of denture/reconstruction cases and can tell you from experience that under NO circumstances will METLIFE pay for implants of any sort and in fact reserves the right to refuse to pay for the denture that sits on top of implant in alot of its contracts. NOW for some of the good news. It is September and most contracts have a calender year maximum. That means that if the extractions are done this year, they will not impact on the next years maximum. ON THE OTHER HAND I do not think you want to go thru extractions and leave an empty mouth until the next calender year starts. Other Dentists on the board have mentioned to you 'temporary dentures' and that is a great alternative. What is meant is that the teeth are extracted and an immediate denture placed. THAT IS GREAT DENTISTRY. The problem is that ALL insurance contracts limit the benefit to ONE denture per arch per five years. SO IF MET were to pay for a denture, immediate denture or permanent denture, they would not PAY FOR BOTH in that five year limitation. POSSIBLE suggestion: extractions, placement of dentures and then retrofit them for implants if and when you are ready. THE IMPLANTS would be totally OUT OF POCKET TO YOU, but possibly the reline of the denture to adapt it to the implants can be legally and ethically billed to Met or any insurer. Please feel free to email me for any more imformation Jeffrey > Marty: there are a multitude of problems, MOST IMPORTANTLY that MET LIFE > will in no way shape or form pay for any sort of implant. > Read your MET contract. Recently I was surprised by MetLife when they covered a patient of mine for his implant surgery with the local oral surgeon. I had (wrongly) assumed that his MetLife dental insurance plan would not cover anything to do with implants. Imagine my surprise when he returned from the oral surgeon with the two implant bodies in place, and his insurance maximum depleted for the year! A call to MetLife confirmed that his policy did indeed cover implants, but at the MetLife PPO rates. Given the usual low yearly limits, it didn't take much to max out the policy. But when his policy-year begins, the patient will undertake to obtain the final two crowns on the implants. So far, that is the only MetLife policy I have encountered that covers implant services. So it pays to check the policy. > I happen to be a metlife provider in New York City [Manhaten] and do alot > of denture/reconstruction cases and can tell you from experience that under > NO circumstances will METLIFE pay for implants of any sort and in fact > reserves the right to refuse to pay for the denture that sits on top of > implant in alot of its contracts. In a lot of its contracts, true. But the MetLife rep was careful to tell me that MetLife offers implant coverage to corporate purchasers who want to buy it. - dentaldoc I would still check the insurance transmittal. Some of the jokesters will place implants, do four quadrants of scaling and root planing, bill the patient for the difference and there ya go .... insurance money is gone! Joel PS~ have you verified that the above scenario is not so? >> Marty: there are a multitude of problems, MOST IMPORTANTLY that MET LIFE >> will in no way shape or form pay for any sort of implant. [quoted text clipped - 28 lines] > >- dentaldoc Bill: such coverage is not only few and far between, for even if it did exist: It would either pay for the implant at the PPO rate, or the Denture. There is no way that his implant and denture would be covered. Additionally the implant is covered only if a crown is being placed on the tooth. OVERDENTURES are NEVER covered. >> Marty: there are a multitude of problems, MOST IMPORTANTLY that MET LIFE >> will in no way shape or form pay for any sort of implant. [quoted text clipped - 30 lines] > > - dentaldoc Thanks Jeff, Good to hear from you. Now Delta Dental around here will not PAY for implants, but implants are on their fee schedule ...... kind of controlling costs ... and controlling dentists .... to benefit their clientele. Joel >> TARGET / GOAL : Dentures: upper and lower, mini implant retained : >> $4,000.00 total. [quoted text clipped - 69 lines] > >Jeffrey |
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