Ripoffs...insurance coding

[Arizona-Willie]

I had a problem with my front teeth.

I was waking up with my bottom teeth pressing hard against the top teeth while sleeping and developed an abcess on one tooth ... apparently from the pressure.

There was no cavity in the tooth and it wasn't broken ... no problem showed on xrays but there was an abcess on the root so I wound up with a root canal and then today I went back and they put a final filling in it.

I was talking with the dentist and conveyed my concern about the pressure. I mentioned the mouth guards and he said he had a lady a few days ago who said she had sleep apnea and was pushing her lower jaw forward too!

So we decided to try a mouth guard to try to protect my teeth somewhat.

It is not the dental type appliance that is supposed to help with apnea.

Anyway, his assistant came in and asked if I had insurance. I do. They checked with my insurance people and they don't cover those.

If the insurance company had covered it ( some do ) the total price would have been $500 and I would have had to pay half or $250.

If they code it as a Night Guard the cost is $500 ... if they code it as activity guard the cost is ----- $230 for the same exact thing.

So paying for it without insurance and coding the right way I get it for less than if it was covered by my insurance.

I realize this won't stop the sleep apnea but perhaps it will help to protect my teeth somewhat. Time will tell.

But doctors and dentists rip off insurance companies like crazy this way.

If they ask if you have insurance say " no " and see what price they quote you. It may be less than your deductible if you use your insurance.

It's no wonder health care costs so much .. at least 50% is ripped off.

[jum001]

Was it dental insurance that refused to cover it? Did they say sleep apnea is a non dental issue? If yes, perhaps your health insurance would provide some coverage. Just a thought.

Julie

[Slinky]

Not a bad thought either!!! And certainly worth investigating! I wonder ... is TMJ considered a dental or a health condition?

[Snoredog]

yeah and what's even more interesting is you can go down to your local drug store in the tooth brush section and get that same boil-n-bite mouth guard for under $30 bucks sold as a sports mouth guard.

[stages3n4]

It happens in all types of insurance. Years ago, I had to get my vehicle's windshield replaced. First place I called asked if it was covered by insurance, I said yes, they quoted me nearly $600, of which I would have paid a $500 deductable.

On the advice from a co-worker, I called a second place, when asked if it was covered by insurance, I said no. Got it for $190.

Go figure.

[DeltaSeeker]

I used to have a night guard because I grind my teeth like crazy. It cost me $100 about 10 years ago and insurance didn't cover it. But it was worth the cost because my teeth were being ground down and cracking. Well then the silly dog had to think it was a chew toy!

My next one was never comfortable so I ended up not using it. (Yeah, yeah, non-compliance!)

So I tried the OTC "Doctor's Night Guard" and thought it was the biggest rip off ever. The thing CHOKES me. It's not at all like the ones made in the dentist office. So I'm back to not using anything. Maybe I should just get the Oracle

Linda

[Slinky]

*sigh* I remember as a kid in school how we learned about the corruption in other governments like Mexico and other countries around the world.

But then as I grew up and moved thru life I began to wonder about those corrupt countries .... if I had a friend in the plumbing business from whom I could get a bath tub at cost but was having a contractor build my house who used a union plumber I "was" going to pay the above cost regardless of where I bought the tub or who I bought it from. The union plumber was gonna get that "markup".

And I'm not slamming the unions. It seems to me the middle class in the US has gone down hill since the PATCO strike and union busting by our then President. I used to laugh when my veterinary referred to our local veterinary medical association as his "union". Except he was right. It did pretty much work as a union.

It seems there is a "kickback" involved in virtually every purchase made in this country. Goshes, even the peanut growers get a peanut subsidy from our government.

[Guest]

I have TMJ and its covered by my medical dr. He prescribed me some meds and had me get a mouth guard from the dentist. It was covered on my dental plan, but I bet the medical ins would have covered it with a prescription from the Dr. Give them a call, worse they could say is no.

[dieselgal]

yeah and what's even more interesting is you can go down to your local drug store in the tooth brush section and get that same boil-n-bite mouth guard for under $30 bucks sold as a sports mouth guard.

I use to have what they called a splint which was made for me by a dentist for TMJ and I quit wearing it several years ago and somehow lost it. Now I am having the same issues and I did try that sports mouth guard a few weeks ago. It helps with the pressure but it isn't exactly like my splint was and doesn't work as well.

[Slinky]

Thanks, Guest/Odawa. I was just Dx'd w/TMJ. Mild, thankfully. Its seems I have none of the "padding" left between the two jaw bones in addition. Joy, joy. The dentist doesn't think a splint will help me. He has suggested "equalibration" ??? We're hoping working on the partial denture will do the trick and NOT have to work on my natural teeth. The partial is such a good fit he was reluctant to suggest we make a new partial. I have no idea which insurance he'll be billing.

[GeneS]

I had a dental device made by a dentist for about 400 that I paid for myself. I then found the snorban device at a drug store. I think you can still buy them on the internet. it cost about $35.00 and is dipped into hot water then you put it in your mouth and form a good fit with your teeth. Try it and you will like it.

It does just what you need and you can tell your insurance company that you do not need them for the dental device. I wear mine with a chin strap and am now expermenting with taping also. It keeps your teeth from grinding , holds your jaw forward so your tongue is further from the back of your throat, and helps seal air from leaking. It used to be http://www.snorban.com.

GeneS

[odawa]

When using the bite splint that the Dentist gave me, I do not have to tape my mouth shut, it just snaps in, & I dont worry about it. When I first got it, I would take it out during the nite, but I'm use to it now and that rarely happens. I think its great. I do not wake up with headaches, my ears are not hurting, neither is my jaw. I highly recommend it. It made a HUGE difference in how I feel.
I am so cute with my splint and hoses at nite. lol