Cost of Modern Medicine, Insurance Reform, and Death in the Paleolithic

Are you going to be finishing all of that mastodon meat?

Cost of Modern Medicine, Insurance Reform, and Death in the Paleolithic

Two months ago, I fell on the ice, was taken to the hospital in an ambulance, got emergency surgery, and two/three days later was released from the hospital. The paperwork I waas handed on my release indicated that the costs to that point were $20,000 US (all covered). I estimate that this injury will cost, medically speaking only, about another ten grand, so the total cost of this injury is going to be, let's say, $30,000.

A few weeks later, a tooth crown that I had had repaired several years ago ("This may last six months, one year tops" said the dentist) finally came flying out of my mouth at a random moment. So now, I'm getting that fixed. Associated with the tooth crown falling off of its perch on my lower left mandible was a nasty little mandibular infection.

So the dentist put me on antibiotics and we started the process of figuring out what to do next.

This tooth needs to be fixed with either an implant or a bridge. The raw cost, before insurance, of both procedures totals to about $3,500. So, about one tenth of the knee surgery. But, there is a question about what insurance will cover (they don't like to cover implants for some reason), so we sent off a request for information along with x-rays to Delta Dental, the insurance company.

Delta Dental screwed up the paper work, so about two weeks went by and we learned nothing, and could not start on the work. So we redid the paperwork, and now another three weeks has gone by, again Delta Dentals' fault, and not only do we still not know anything, but the infection is back, somewhat worse than it was before.

So now I'm on antibiotics again. The pisser is this: If Delta Dental covers my implant, they still would only cover part of the procedure. If they don't cover my implant, they will still cover the new crown, because they cover crowns (to 60 percent only). A bridge requires three crowns. So, when you do all the math, the answer we will eventually get from the Delta Dental insurance company ... a "yes" or a "no" on the implant ... will make a difference of about $800.

A mandibular infection can be a very serious matter. I've got an open hole in my jaw where bits and pieces of root canal stuff occasionally falls out into my food. And the dental insurance company can't handle the paper work to the tune of going on a month and a half of time.

There are certain contrasts that come to mind.

In the paleolithic, I probably would have lived form the knee injury, but only after a long period of painful recovery, and I undoubtedly would have lost the use of my right leg. But my fellow hominids would have brought me bits of mastodon and cooked roots, the occasional kidney from a deer, maye a dead lizzard, and so on. I would live. In fact, I might even have been able to do something useful. But, in the paleolithic, this tooth infection would likely have killed me. These things, eventually, are often fatal in the absence of dentistry and antibiotics.

Yet the surgery costs ten times what the dental work costs. Also, people tend to complain mightily about the cost of dental work. But really, given what you get (you get to live!) it is really a bargain.

And, finally, Delta Dental leaves something to be desired. Listen; If I suck on my tooth I can taste the infection inside my jaw. Thanks Delta Dental. Great work. I'll bet your fucking CEO never had to wait this long for what amounts to emergency dental work.

I'll update you later on how it all works out. At the moment, if you have a choice, and one of your choices is Delta Dental, I'd consider the other choice. And let this be a lesson to us all!

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Man, you are not living right. Two major medicals in less than six months. I'd go with the implant, even if you have to pay for it yourself. Corrupting two presumably sound teeth to make a bridge can't be the best choice. I have an implant and have way fewer gum issues with it than I do around the crowns I have. Good luck.

Unfortunately, as far as the CEO of that company is concerned, the only thing to worry about is whether or not you will continue to pay them more money than they pay out to you.

Lessons: 1)dental problems are serious. Prior to ~1900, dental problems were a leading cause of death. 2)insurance cos. are in the business of ripping people off. They invoke trust in their ads, then betray that trust. 3)much dentistry in the US is still fee-for-service, so costs are not as insane as in the rest of the broken medical system.

While the insurance may not cover much (or any) of the actual implant, they'll probably cover at least part of the procedure to extract the what's left of the tooth and to clear the infection away. I'm confused as to why you are waiting to do this, as I'm pretty sure that you'd need to have it done first whether you eventually get an implant or bridge. I know for my implants, I had to wait at least 3 months after having my healthy baby teeth (I'm missing the adult teeth) pulled for the bone to grow back into the extraction sites before the posts could be placed. I can't imagine that they'd agree to place the implant post into a gaping abscess.

Kierra, when the altnernative is a bridge over an existing root canal, the next steps may be different, so it is wise to know what the final procedure will be first, although there is a version of this that could be started. Also, there is another consideration: My preferred dentist does not happen to be in my plan. So, the procedure is still covered, if it is covered, but not to the same extent. And, I do not assume that an insurance company will agree to pay for something that has already been started ... I've never, in my entire life, seen an insurance company do something that would make me trust them.

The good news: I've finally got the word from Delta Dental as to what they cover, the'll cover half,a nd I have an appointment to start the procedure in just over a week.

Yes, but in the Paleolithic you didn't need dentistry because you could have gotten someone to chew your food for you. Try finding that now, or getting insurance to cover it. I don't think so!

I do not assume that an insurance company will agree to pay for something that has already been started ... I've never, in my entire life, seen an insurance company do something that would make me trust them.

Okay, that makes sense. I guess I was kind of assuming that all dental insurance was billed per procedure like mine is.

Kierr, ours is billed like yours. It's just that the first thing you'd do to put in a bridge is to file down two otherwise perfectly good teeth and part of the process of cleaning out the roots of the other teeth. Then you'd fill the roots, and start bridging. For an implant, you remove the roots of the other teeth. So while insurance does add it all up separately, they are simply not the same procedures.

(The tooth that fell off was a cap on a root canal, and the peg on which the cap sits was reconstructed. For a bridge, it could be just flattened down and filled like a pothole)

When an insurance company says it will cover "half", you need to ask "half of what". Its idea of half may be half of its "allowed amount" which may be far less than the dentist charges. And if the dentist is not in the Delta Dental network, the dentist has the right to collect the half of Delta Dental's half as well as the difference between this "half" and the dentist's fee. Using insurance company math, you may well end up paying two of three halves of the total charge.

And don't forget about the lifetime maximum on the policy. Dental insurance usually has a small lifetime max -- typically in the low thousands.

The health insurance system in our country and most others is a complete mess. The biggest problems are the laws that allow individuals to sue insurance companies and hospitals for exorbitant sums. We have the attitude that these companies are wealthy and huge so "you owe me". It's a welfare state mentality.

The problem this creates; is then the insurance companies reciprocate by taking it out on the rest of us to recoup their losses. Which is why you constantly hear of insurance companies denying claims that are perfectly legitimate.

In fact, that is the insurance company business model today. Deny coverage until the customer throws a fit too big to put up with, then we'll pay the claim.

What ever happened to the customer is always right? What happened to giving a quality product for services rendered? What happened to doing what you say you will do? What happened to our country?