[color=red]Dental HMO nightmare! I'm so sorry I got braces[/

[HotWire]

This is a warning story for everyone who happens to belong to a Dental HMO. Mine covered adult orthodontia, so I thought, what a great deal.
I trusted that, even though they were an HMO, they couldn't mess up my healthy teeth.

This was elective orthodontia, my bite was perfect. And I only needed 1 tooth straightened.
So how hard could that be?

Willamette Dental ended up misdiagnosing the symmetry of my jaw structure. The X-Rays they took of my face, which would have showed that my jaw structure was asymmetrical (showing 1 condoyle shorter than the other), was so dark you couldn't see anything.
They didn't bother to take another X-ray.

They pulled 1 tooth and put braces on my lower teeth. When they pushed my teeth in symmetrically, they made my jaw even more asymmetrical.

As a result, I had severe TMJ and I'm now left with a severely open bite.

After 1.8 years in their lower metal braces, I now NEED full mouth braces and jaw surgery. No choice in the matter.

I can't chew on either side of my mouth, my smile is weird, and I'm in extreme discomfort.

What's worse is that they won't own up to their mistakes - I filed a complaint about their misdiagnosis leading to my current situation and they denied it.
But I can appeal. And I will pursue all legal action.

Any advice from anyone who has gone through a disaster like this would be appreciated.

I'll fill out the details and post pictures later, but I just got their letter denying any wrongdoing and I needed to vent.

I'm so sorry I started on the braces road. So sorry that I went with an HMO plan which therefore didn't allow me to get different diagnoses (I wish I had done this with those ortho's that give you a free consultation).

To those just starting on their braces journey, make sure you get a thorough diagnosis up front from someone you trust. It will save you a lot of grief, pain and money in the long run.

I now face over $13,000 worth of orthodontia and oral surgeon bills.
Just because I thought I could save $3000 on ortho bills by going with the HMO.

[hot blu teeth]

that really stinks! good luck!

[Brooke]

WOW I am sorry to hear that you're dealing with this mess. If I were you, I'd probably see a new ortho to deal with the correction of my teeth. Secondly, if you were wronged... fight it until the end. I know that right now there is no light at the end of the tunnel... but you will get there. I would like to see pics when you get a chance to post them. I guess when they say second opinion are essential, they weren't kidding. I hope things start to look up. Think positive, and I am sure you'll come through just fine. Keep me updated. I'd like to know if things are going ok for you.

[HotWire]

Thanks for your comments! It always helps when you know there's people who can understand and relate to what you're going through.

I actually have just had my 2nd set of braces put on this last Wed, the 26th.

I had bands and ceramic uppers put on Wed. and 2 lower bands. I go back in a few weeks for the back
upper bands and lower metal braces.

He thinks the jaw surgery should happen in 8 to 10 months.

I was lucky enough to find an ortho who's a diagnostic genius.
He took a look at the way my jaw moved when I closed my
mouth to bite, and before even looking at the X-rays,
and before it was physically evident (after wearing a splint for 1.5 mos. to correct my bite, the open bite is very obvious)
he saw that I had an open bite.

So I feel that I'm in good hands now. I just wish I had started out with this ortho to begin with.

[Brooke]

I am so happy to hear you found a great ortho. I think it'll look up from here. When your teeth are done, you sure will appreciate it more! Too bad you had to go through this first. It's great that the new doc is so educated. I am sure that'll make this a lot easier on you. Let me know how this works out.

[missingu]

Hotwire-

Though I did not take action against a dental HMO, I took a complaint about Aetna and a "very prestigious hospital" (need to remain nameless) to my state's Health Services Cost Review Commission contending price fixing. The end result - the hospital owned up to their "error", of billing Aetna $433 for a procedure that should have been billed $80. Even better - when the Rate Commission informed me of the hospital's admission of wrongdoing, the Commission indicated the hospital had to go back and correct OTHER people's bills that had been billed under the wrong amount, too!

I'm not quite sure who is liable for the monies you have spent, but I strongly recommend that you NOT try to go this alone. In Maryland (the state I was battling) we have the Maryland Insurance Administration to help consumers, and they are great. As stated on the web page:

"The primary role of the Maryland Insurance Administration is to protect consumers from illegal insurance practices by ensuring that insurance companies and producers that operate in Maryland act in accordance with State insurance laws. We are here to assist you with your insurance inquiry or complaint about health, life, property and casualty insurance.

THIS IS WHAT WE CAN DO:

* Forward a copy of your complaint to the insurance company, if appropriate;
* Obtain information or explanations on your behalf from the insurance company or their representatives. This may involve written and verbal contact with such companies or persons;
* Review in detail the information obtained from the company for compliance with statutes, regulations and policy contracts;
* Explain the provisions of your insurance policy, as appropriate;
* Suggest to you actions or procedures that you may take which could aid in resolving your insurance problem;
* If it is determined that the actions of an insurance company are in violation of a statute, regulation or policy that the Administration enforces, we may take corrective action against that company. "

Further, they are free because it is taxpayer funded and a service the state provides citizens.

If you are going after the HMO per se, definitely google "insurance administration (or commission)" and your state name to get the agency that does the equivalent. If you are going after the dentist per se, I still recommend talking to the state insurance agency if it comes down to money, or you can consider filing a complaint against the license of the lead ortho if you feel there was individual negligence. Won't get you money but will alert others to his/her practices.

Generally oral surgery is covered under major medical, but I don't know your policy. If you trust the current ortho, he can probably help you and the OS present your case as medically based, not dental, and health insurance will hopefully pick it up.

If your state does have an insurance commission, please go through them first. When an insurer gets a call from the commission, they know they are in trouble. When they get a call from one of us peons, they just ignore it most of the time. Use as many resources as you can!

Good luck and I'm sorry you had to go through all this.

[HotWire]

Thank you so much for the information!! I will start looking on the internet right now.

I had already planned on filing a complaint with the State Board that oversees Dentists and Orthodontists, so this will be 1 more possible way to at least voice my concerns over what has been done. And to try and prevent it from happening again.

[missingu]

Dental HMO = Dental Health Maintenance Organization

In a nutshell, US health/dental insurance policies are either PPO (Preferred Provider Organization) where you can go to any provider you want who accepts your policy. Or they are HMO (Health Maintenance Organization) when the insurance company limits the choice of providers to only ones the insurance company selects who get both perks but pain for being on the "HMO provider list" for the insurance co., including allowing the insurance company to dictate an incredible amount of the provider's procedures (i.e. how many MRI orders can be written in a month...)

So, I might have BlueCross BlueShield (the biggest health insurance co in US) for health insurance, but when calling to make a doctor's appointment, the doctor will ask me if it is PPO or HMO. If the doctor is not an HMO-identified provider, even though the doctor takes Blue Cross Blue Shield, if I am HMO only I cannot use my insurance card at that doctor. If the doctor is PPO, then I can go there. If I am Blue Cross HMO, I can ONLY go to one of the selected Blue Cross HMO doctors, period.

The issue has to do with reimbursement and "automatic selection" of patients for the doctor (or dentist) by agreeing to be HMO. Patients save money by electing the more restrictive HMO, but as Hotwire found out, sometimes the HMO doctors/dentists just aren't as good as those who have to compete for patients. HMOs work great for some people, but they can be a gamble.

[fins]

Sorry to hear about your problem. I hope your new ortho gets things done right for you in the future.

You really should consider retaining an attorney at this point to see where you stand legally. This does sound like negligence. You should be able to sue for the attorney fees as well as pain and suffering.