Adventures in Tooth Care Adventurous/Terrible/Expensive, Even With Insurance

by Sarah Sluis

One look at all the white spots on my x-rays, and it’s clear I am the kind of patient who makes dentists lots of money. I have had tens of thousands of dollars in my mouth — fillings, crowns, root canals, dental surgery, and much of it has come from my pocket. I am lucky enough to have dental insurance, but it’s not a pay-all, cure-all.

Last year I had my first experience with double treatment. A few days after getting a chipped filling replaced ($36.40 out-of-pocket, $145.60 out of the $1,500 coverage I had for the year), it started to hurt. I was biking home, and the wind sent lightning strikes of pain up through my gums. I pulled air through my tooth, checking to see if it triggered the pain. Yep.

My emergency appointment with my dentist where he did the cold test, cost me nothing. This is the cold test: He puts something cold on your good tooth, and it feels cold. And then he puts the cold probe on the sick tooth, and suddenly you have the absolute worst nervy pain radiating all the way up through your nose. Then your stomach feels sick because you know you have a damaged tooth, and thousands of dollars of work in front of you. The fact that I had just had a filling redone on the same tooth was just “bad timing.”

I went straight to the endodontist, or root canal specialist. Despite my experience with tooth pain, I have low pain tolerance, and I want it to go away immediately. The endodontist told me that sometimes people split up their treatment over two calendar years — root canal one year, crown the next. Because the tooth was farther back in the mouth, I would also need a crown (estimated $1,000). I decided to get the root canal ($2,390 billed, $1,326 contracted amount. Cigna paid $506 of that, I owed $779.60. Although the procedure was covered at 80%, I had already maxed out the annual coverage) and the required “post & core” treatment ($264, Cigna’s contracted rate but no insurance left) in 2012, and then delay getting the crown until 2013. It would save me at least $500, since crowns are generally covered at 50%. Plus, I could put money in a flexible spending account, giving me a further tax-free discount of about 30%, bringing my savings up to about 70%, or $700 off the total cost. It was a great idea, do it! It just didn’t quite work for me.

Our company announced they were changing insurers for next year, throwing my plan into disarray. Reimbursement rates were lower for out-of-network dentists — and required a $150 deductible. And I couldn’t wait that long. I got the crown, but my anticipated savings of $700 went down to around $400 — and it could eventually be less if I still owe money after the claim is settled. So I waited a couple of months to finish dental treatment for what ended up being maybe $400 in savings.

Although that amount is still a pretty sizeable chunk of my paycheck, it came at a high emotional toll. Now that my crown is in place ($633), the pain in the rest of my mouth has diminished, but I’m still in fear that more of my teeth will fail. The pain in that one tooth cost me $2,000, and I have 27 more teeth. My next cleaning and x-rays are in a month, and I might need a therapy session if my dentist finds a cavity. My mouth is a ticking time bomb. Every time you put a filling in a tooth, it weakens it, making it more likely that a tooth will require root canal treatment — or worse — in the future. Fillings have a lifespan of a decade, meaning my teeth will always require expensive maintenance. I’ve already crossed the line from being a compliant patient to a compulsively neurotic one. He better at least tell me my gums look good from all that flossing (I’m an Oral-B Glide girl, $3.80).

Sarah Sluis has a great/expensive smile.

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