petitefrancaise

the thing about going to see a new dentist is that they don't know you, your habits, your diet, your toothbrushing skills,how quickly your teeth decay, gums react etc...

They can only look in your mouth and see what is there, right then. They will want to change any filling that looks slightly dodgy, get you going to the hygienist every 3 months until they can see you looking after your teeth really well.

What's perfect? What's "just " healthy and what's perfectly healthy though?

You can always ask the dentist to mark things down as "urgent" "6-12 months" "1-2 years" so that you can budget for it.

I was talking to a maxillofacial/oral surgeon last week, he takes medicaid patients and there's only one other oral surgeon in Austin who does, out of 65. He told me of a high school kid from a "wealthy" school who couldn't find anyone to take out her wisdom since mum's job was canteen worker and the whole family on Medicaid. Another 31 yr old woman who had a swelling on one side of her face, no insurance and dentists locally just gave her antibiotics. It was a tumour and she's going to need half her lower jaw replaced, so he's doing it pro-bono at a local hospital that has agreed not to charge her.
Stories like this make me cry and wonder why I moved here.

Nutmegger

It's sad there are so few doctors with a philanthropic bent. My late f-i-l was a dentist (Yale and Columbia), who stayed in the neighborhood where his office was as the infrastructure deteriorated, and took care of the disadvantaged people who moved in. My OH's friends used to call him -- lovingly, I should point out -- the ghetto dentist. So he never got rich like his classmates -- but it shows there are some good folks around.

I have been extremely happy with the dentistry in this country. I had my mouth just about destroyed by a NHS dentist in Yorkshire in my youth and it took a decade of three different dentists in London and then NYC before all the damage was sorted out.

Lion in Winter

I would also like to add that most orthodontic work is considered cosmetic and not a medical necessity. As such, it is not covered by any health insurance policy that I have seen recently except for a (in the ones I saw and have) lifetime benefit of $1,500. Anyone who has had any orthodontic work knows that that hardly gets you in the door.

If you get braces, etc., for your kid you are going to pay for it yourself for the most part and it's very, very expensive. Rules out a lot of people. I am in the middle of getting my son's done - a little late at 15 but literally could not pay for it before - and it's costing me about 6k, not including any retainer he will need when we're done. It has made a huge difference to him and I'm glad to have been able to do it finally, but

petitefrancaise

Yes, this guy is one of the best oral surgeons I've ever come across, he set up Dell Childrens Hospital special needs dental unit, he's got 3 degrees, does his pro-bono work out of hours and most evenings are spent in the OR doing the free surgeries. He's been trying to hire a fresh-out oral surgeon to train the way he works but he can't afford them. The last guy he interviewed owed $420K in college bills for the 10 years his dental /oral surgeon training took so he took a job for $350K pa can't blame them really.
Very sad state of affairs.

Nutmegger

One of my veterinarians told me that she will finish paying off her college loans just as her son (now 6) is ready for college. It really is an incredibly daunting proposition.

Bob

If you've got dental insurance, they should have a list of providers. Ask friends/colleagues about a few of them for recommendations.

If you've got to pay out of pocket without insurance, perhaps look at a local dental school, though would be limited to term time, but they are often pretty good and not over the top in cost.

petitefrancaise

I would ask for recommendations first, then ask if they are in-network for your insurance. If they are, great. If they're not then I wouldn't write them off and here's why.

Sorry if this is teaching some of you to suck eggs but I think it's worth repeating.

In-network dentists have reached a financial agreement with the insurance companies. They will do procedures for the price that the insurance has said they will pay and usually this is on the low side. Something has to give - either time taken for the procedure is shortened, cheaper materials/labs used or it's someone less-experienced. Rather like the NHS dentists in fact. In any case, the insurance will only pay a certain amount (usually 100% for check-ups and cleanings 2xyear, 80% for rootcanals/perio surgery, fillings and 50% for crowns)

An out of network dentist may still accept your dental insurance and this is in part-payment of the bill. BUT the out-of network dentist may charge you more (or may not) You still have to part-pay (co-pay) and a good insurance won't have much of a difference between what they will pay in-out of network since they're going to pay the same anyway.

My insurance, Humana, pays out roughly the same whether the dentist is in or out of network since they a range of prices they will cover but there is a $2k limit per person that they will pay out each year.

Mrs Danvers

Indeed. I believe I had 1k covered of my daughters treatment and paid $3800 myself. That was six years ago.

petitefrancaise

It's worth taking the younger kids to a good paediatric dentist since they know that some kids' teeth can be straightened just as the adult teeth are coming in (6-8yrs old). They use a removable retainer for about 6 months or so to create space for the rest of the adult teeth to come in in a good position - no overcrowding. This is a LOT cheaper/quicker and more acceptable to the children as well. Oh yes, and done at this stage tends not to need retainers for the rest for their lives.

Lion in Winter

It wouldn't have worked in my son's case (not an overcrowding issue and he would have needed work later anyway as it turned out) but in any case - cheaper, but not cheap or even doable if you really have no money. And I didn't. Many don't. Not a great feeling when what you want is the best for your child.

petitefrancaise

Yes, as you said, it's not suitable for all cases but where it can be done, it works really well. I haven't looked into the cost of this in the USA - we did it all the time in France and charged the parents €300 or so + the monthly €23 consultation fee. So, about 10% of the cost of full ortho. I assumed it would be the same here. silly me.

MarylandNed

My dental plan covers orthodontics up to a lifetime max of $2500 per person. All 4 kids have had treatment. It doesn't cover the full cost but it's not to be sniffed at either. Every orthodontist I have dealt with has also set us up with a monthly payment plan. In addition, you may be able to contribute to a pre-tax healthcare account (e.g. FSA, HSA) and use the funds to pay for orthodontic work to further offset the costs. I have done this with both HSA and FSA.

Bob

It's going to depend on location and on insurance.

Where I am, there are loads of dentists, so going out of network doesn't really make much sense because doing so means you pay all the cost, so you might as well not have it.

Going in network usually gets you a couple of cleans and check ups a year and a chunk of money towards work done.

Considering a check up and a clean can easily be $250-500 if you had to pay up, finding a in-network dentist makes sense.

Marc_ely

We're just finding new dentists now.
We've had some poor experiences so far and I am now left with a big bill. Lessons to be learnt for newbies below...

The first Dentist we picked was recommended to us by another expat (not on here). My wife went first just for a checkup. The dentist took one look at our insurance plan and then worked out how he could get the most from it by creating a long list of things to fix and a schedule etc. She has nice teeth (for a Brit anyway) so was pretty horrified by the outcome. She tried a couple more and both said the first guy was talking rubbish.
He was an in-network dentist and quite frankly, a charlatan.

The second dentist we went to was recommended via a US friend. They came to the same conclusion about her teeth - i.e. they were basically sound. The kids went for checkups. My wife had a couple of small fillings done and I then went in... with my lovely (ahem) British teeth. I was diagnosed with gingivitis and was prescribed 4 quarters deep cleaning. And one of my fillings needed excavating.

I then find out AFTER we'd had the work done that they weren't in-network. They told me that the percentage payouts are largely the same as in-network. The insurance company verified that.
But what I didn't understand was.... if the dentist is in-network and wants $350 for a filling but the insurer only pays $150 then the balance of $200 disappears. Nobody pays it. But if you're out of network the balance comes to YOU.
I now have an $1800 bill for the family visits. This is for 3 fillings, 4 quarters cleans and 4 checkups. If I'd been in-network I think the cost would have been nearer to $400 for the lot.

So from our experience so far I conclude that in-network dentists will try and find stuff wrong so that they can get their money, and out-of-network dentists will be more honest but you'll pay more. I'm hoping there is an in-network dentist that is honest somewhere too, because I am an optimist!

As for orthodontics my insurance gives $1000 per lifetime per person towards them. My eldest boy (10) has just started treatment and over 18 months it's going to be $2800.

Lion in Winter

Indeed. And $2,500 is a very generous plan. The HSA is what I am now doing since I finally have the kind of job that offers that kind of benefit. I was referring to when I did not, and to the many, many who still do not. Monthly payment plans do not make it cheaper, they only spread the cost out. Mine are spread out so that I pay just over $200 a month after a down payment - that would still have been impossible for me to cover two years ago. When you are truly poor, orthodontic dental treatment can be next to impossible to obtain.