Since we have kids of the age (less than 19) that might be going through the wisdom tooth thing, I thought I’d check here for any experience with coverage under Obamacare (PPACA).
Has anyone been able (or tried) to get their PPACA policy to cover “third molar” (aka wisdom tooth) extraction for their age <19 kid?
I resisted having my daughter’s wisdom teeth removed, but she started having impaction issues, so since she was less than 19 at the time, and the policy said (extracted salient parts):
I thought “How can they wiggle out of that?” Well, they (BCBSNC) are trying mightily to do just that.
I’ve done a little searching and found a few pre-passage (of the PPACA) discussions that said that there was a wish that there was more guidance on the more expensive procedures (like wisdom tooth extraction). Apparently the law says “medically neccesary”. Maybe that’s the wiggle room? My thinking is that if one insurance company is paying for certain procedure codes (involving impaction of wisdom teeth) and another is not, then one of the insurance companies is messing up.
Any experience out there, or hints for finding a precident?
Ours was covered by dental first, then submitted to medical as well. Neither kid had their wisdom teeth extracted as an elective procedure. Both had impacted teeth that were causing problems with other teeth.
Our coverage, however, did not exclude wisdom tooth removal.
My oldest has his wisdom teeth (had braces, but had room). #2 had his wisdom teeth, but one fractured his junior year in college and had to be removed, it was submitted to medical by the oral surgeon. #3 had all of his removed because of space issues and his was submitted to dental and the balance to medical (an oral surgeon did the work).
Our insurer covered wisdom tooth extraction and other dental work as medical under H’s plan as a federal employee. He’s now retired but covered our kids until they were 26.
Health insurance is state regulated, and some states require some dental (especially for children). It won’t really help if 20 people from Colorado tell you it was covered and you live in Ohio. You need to research locally.
Ypu need to research YOUR plan. Some dental and medical plans are “richer” than others. The state specifies a minimum…but different providers within the state likely provide more. You need to check YOUR plan.
As an aside, our oral surgeon did all of the insurance checking for us before the kids had their wisdom stretch extracted. We knew up front exactly how much it would cost.
And be prepared…oddly, the only thing not covered (and we heard this from many folks…same thing) was the anesthetic. Like you can have Silom teeth pulled without it! Wasn’t covered for either of my kids…or any of their friends. YMMV, of course.
Happykid’s impacted teeth were covered by both the medical and the dental. The non-impacted teeth were only covered by the dental. Anesthesia was covered by both, and certain X-rays were covered by one or the other. The oral surgeon was chosen from a list recommended by her regular dentist, and based on that oral surgeon being in-network for both the dental and medical.
The office manager filed only for dental, and had to be reminded to file for medical as well. So if you have dual coverage, helicopter that one too.
Our D wanted gas rather then a shot for sedation. That wasn’t covered by insurance. I agree that YOUR contract is where to start. The oral surgeon gave us an estimate based on what others in the same policy paid and was correct.
Medical insurance seems to cover part of the extraction.
How did coverage compare for your older children?
We do not have coverage under the ACA, and was disappointed that the extraction wasn’t covered better. While medical covered part of it, it was limited to a set amount, as well as a percent.
Even though the surgeon was on their list of " preferred providers", they were not restricted by what they could bill.
Dental coverage is much poorer than major medical, and doesn’t cover things like bite guards at all. Then again coverage for things like eyeglasses hasn’t been increased for years.
( nor has mental health coverage)
Actually, insurance is really to cover catastrophes like cancer, Hospitalizations,etc., not things that make us wince and wish were less expensive but predictable like glasses, even dental care that is under 5 figures. Yes, it would be nice to have lower costs for these, but not NEEDED that we cost share theses items.
well, I pay for a vision plan and therefore glasses are covered, and I pay for a dental plan and therefore my dental services (including cleanings,) are covered. I don’t know about my current health plan (which I pay for also) but when my own wisdom teeth were extracted I think it was dental first and then leftover would be covered by medical.
As others have said check your specific insurance plans (may need to call and ask the prospectus are difficult to read and understand.)
Just in the middle of this. Our broker told us that the ACA, which was supposed to cover dental starting in 2014, but is required to cover it in 2015 and beyond, will cover it. When we checked further, the co-pays were ridiculous. The anesthetic is the big-ticket, as @thumper1 says. We ended up purchasing a policy (non-ACA dental) for about $15/month for the child. Extraction of all 4, including varying levels of complication, will still run about $1.5k out the door. This is in-network.
Yes, our insurance paid some 30-50% and we paid the rest. Our portion may have been $1500 or more. Then we had to buy ad smoothies because she wa very afraid of potentially dislodging the blood clot and having painful dry socket.
I realize insurance is there in case your house burns down, but why can’t eye glasses be covered at a percentage, not a flat fee, that has gone up maybe $5, in the last fifteen years, while my eyes have gotten substantially worse.
Glasses are much more expensive than contacts, but the amount the insurance covers is the same, and I can’t wear contacts often.
My H hasn’t even gone to the dentist in years, because he needs lots of work, and he doesn’t want to go through that ( or pay for it)
I don’t go either because I don’t like the numbers of X-rays they want to do.
id like an option to pay for better coverage when you have insurance through your employer.
They do have several policies to choose from, but all cover less than they did ten years ago.
At least they keep making changes in tax law to keep it interesting. http://krqe.com/2015/01/18/new-tax-forms-to-fill-out-on-health-insurance-coverage/
Kiddie—vision and dental plans have caps and are not truly insurance. If you max out your plan, the rest of the year’s expenses are yours out of pocket, even your dental cleaning, because your plan has paid its yearly maximum.
I years ago switched to a preferred dentist and don’t even have to fill out paperwork for my dental plan - we have had out-of pocket dental expenses (for big things like crowns and root canals). The plan also covered a percentage of my daughters orthodontic expenses (but that was a long time ago and I don’t remember how much)
For vision, with two eyeglass wearers in the house we calculated that the vision plan premium would be less than the 2 annual exams (and typically each family member is covered for new lens each year and new frames every two years.) Yes, we always end up with out-of pocket expenses on new glasses (coatings, or thinner lens) but still feel it saves us money.
When I calculated the “dental” and “vision” riders we could have gotten with H’s federal plan, you were basically pre-paying for expecting to use the dental and vision – exams and glasses or contacts. To me, it just wasn’t worth it to pre-pay them and limit where I go to get my prescription filled or reimburse me at a lower rate for “nonparticipating” optician. I just get glasses and contacts at Costco and have been fairly satisfied. It’s cheaper for us than buying the vision and dental riders.
The insurers figure they are for the MAJOR expenses–like if you need surgery to save your vision, etc., not to help with the predictable annual or biannual expenses of glasses and/or contacts. I’m happy they don’t raise everyone’s premiums so we can all have this “free” benefit, when we really don’t ALL want it for the amount they want to raise the premium and the paltry benefit they’d pay.
