Debunking Dental Insurance Part 3: When cost becomes more important than care

Over the last several weeks, we’ve taken a look at how the dental insurance mindset can often keep patients from dental health. We’ve debunked a number of myths and discussed the problem with completing dental work $1,500 at a time. Another situation I see that can get patients into trouble is when cost becomes more important than care.

Of course, I understand that everyone has financial obligations, and cost is often a factor in many of the decisions that we make. However, I bring up this topic to emphasize the preventative side of this issue and educate patients on the importance of choosing the best treatment plan for their long-term health.

A prime example of this is a patient who I have been seeing for many years. Although our practice was out of her insurance network, she valued my opinion and paid out-of-pocket to have her cleanings done in our office. This patient was missing several teeth and, as a result, began having some TMJ issues.

There were three possible approaches to treatment:

  1. A partial denture. Knowing the patient’s personality and her aversion to wearing a partial denture, I did not recommend this option. However, her insurance provided the most coverage for this treatment, bringing her total out-of-pocket cost to $1,200.
  2. Two fixed bridges. This option would use two bridges to close the gaps where her teeth once were. While this was a better option, I also did not recommend this treatment because the teeth that would be bridged were in perfect condition and the bridges could further aggravate her TMJ issues. The total out-of-pocket cost for this treatment would be $7,000.
  3. Two implants. This option would be permanent, would not jeopardize the integrity of the adjacent teeth and would not affect her bite or aggravate her TMJ. Out of the three possible treatment plans, this was my recommendation. However, this option was not covered at all by her insurance provider, bringing the total out-of-pocket cost to just under $8,000.

When it came time to make a decision, the patient chose to have a partial denture placed by a dentist within her insurance network. She wore this for a year and hated it, so her in-network dentist recommended that they do two bridges. However, she had to pay out of pocket for these because she had already applied her insurance benefits toward the partial.

After the bridges were placed, she immediately began having tooth pain and TMJ issues, which resulted in two root canals through her new bridges. However, the root canals did not fix the pain, because the pain was coming from the bite problem.

At this point, she was out $10,000 and was in worse condition than when she started. Unfortunately, it gets worse. In order to ease the pain, the patient had her back two teeth removed. The dentist fitted her for another partial denture; however, she chose not to wear this because of the discomfort that it caused.

This could have been avoided if the patient chose the most appropriate treatment plan right out of the gate. In the end, it would have saved her time, money and the pain that she endured for many months, if not years, trying to treat this problem.

This scenario happens all too often, which is why I base my treatment plan on the particular patient and not what their insurance covers. It is my job to be your advocate and to help you make the best decision for your long-term health.

If this sounds like the type treatment philosophy that you’re interested in – call us at (813) 689-4226 to schedule a consultation today.

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