no insurance for braces, but extractions?

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#1 Post by **godawgs** » Thu Feb 16, 2006 4:40 pm

my ortho has recommended extraction of 4 teeth. my dental insurance doesn't cover orthodontics, but extractions are covered. for those of you who have had to deal with this, do dental insurance companies decide whether to pay the benefits based on whether the extraction is cosmetic or non-cosmetic? even though extraction is listed, i'm worried that insurance will refuse to pay b/c i'm only getting the teeth pulled for braces. thanks!

#2 Post by **joygoss** » Thu Feb 16, 2006 4:53 pm

I haven't had to deal with extractions, but unless your dental insurance lists cosmetic extractions an EXCLUDED BENEFIT, it should be covered. The safest way to handle the situation is to contact them yourself and give them all the details just to make sure. There may be some aspects of your treatment that are covered, such as x-rays, etc.

It's always good to know your benefits before you get any kind of treatment. I'm a medical insurance billing specialist and I'm DELIGHTED when patients are aware of their benefits before they begin treatment.

Good luck! [/u]

#3 Post by **Dreamer** » Thu Feb 16, 2006 5:08 pm

Godawgs.. I was in the same situation with my insurance and they paid for my extractions 100%. The reason being is that even though your braces may be mainly cosmetic, they are also to insure that your teeth wear properly as you age and so if the extractions are prescribed by your orthodontist then they should be covered. Most oral surgeons call to verify the coverage before your extractions anyway so if there was a problem with your insurance they would know prior to your appt! I had 4 extracted as well..wasn't that bad surprisingly! Good luck!

#4 Post by **sydsmom** » Thu Feb 16, 2006 9:03 pm

hmm...hopefully this doesn't happen to you, but my insurance supposedly covered extractions, too -- until they learned the extractions were for ortho. Those weren't covered, and cost me $114 apiece

My insurance doesn't cover ortho period. But yours might be different; it would definitely be worth a phone call to find out.

#5 Post by **Harpua** » Thu Feb 16, 2006 9:49 pm

Also posted in the other thread (bottom line, talk to your insurance company and if its not complicated, consider the alternative to surgery):

I had 4 extractions 8 days ago and it was no sweat, other than having to be careful eating, but I've already healed pretty well and it was a piece of cake to have done. A general dentist removed my 2nd bicuspids (including one baby tooth) under local anasthesia. Needle hurts a bit numbing it up, but he got them each right out in no time - like 15 minutes all together. They were huge! Have some good souveniers. Put a single stitch on one for good measure and it came out 4 days later when I got my teeth cleaned. The first day, I took a couple of hydrocodone and kept one of those freezer gell backs around my face for the rest of the afternoon. I really wasn't that put out by the whole thing physically - or financially for that matter. I was expecting my insurance to just snub their nose at because the policy mentions that the regular benefit schedule doesn't work for orthodontic motivated treatment, but I did get somewhat of a discount still and it cost me about $230 dollars for the whole thing. I had previously been calling oral surgeons out of fear of the procedure and they were quoting my $700 or more with a 'discount' for my insurance plan membership. I was definitely pleased with that, and now after having my doc throw in 6 free ceramics (originally quoted at $500 dollars more), my attitude has gotten a lot better about this whole braces thing! Good luck to you - this forum has been great in building my confidence navigating this whole mess!

#6 Post by **Anticipator** » Fri Feb 17, 2006 9:00 am

I'm not sure on my current plan, but I know that a previous dental plan through my company did not cover extractions necessary for ortho.

I know that my general dentist was also doing an "interesting" job of explaining to me why my wisdom teeth needed to come out, which I assume was her way of convincing my insurance to cover the extractions.

#7 Post by **godawgs** » Fri Feb 17, 2006 10:15 am

thanks everyone for your helpful advice. i will have my oral surgeon call the insurance company tomorrow.