Dental Woes, Ctd

by Chris Bodenner

A reader writes:

I was in a bike crash last summer that put me face-first into the pavement at 20 mph. I lost four teeth, broke my neck and that little bone in my throat (the hyoid), and nearly had my lower lip ripped off. I could have been killed or paralyzed, but wasn't, and recovered well. The hospital bill was in excess of $35k and included emergency facial surgery, where my lip was sewn back onto the base of my gums and asphalt fragments were scraped out of my lower jaw (yikes, that was the worst!). My insurance paid 90% of it, since I have a solid benefits plan through my well-funded startup company.

Now there was the matter of those four teeth.

I first had to wait until the swelling went down, the sutures were removed, and my gums were healed. Then one of my several dentists cut into the scarred gum tissue, applied a bone graft, and put more sutures in the same tissue. As you might guess, my dental insurance (Delta Dental) will hardly cover anything - about 10% of an amount nearly the same as my hospital bill. I only get that much because my care will span two years, so I can claim the annual maximum coverage twice.

My story is about a single accident, not a disease of the teeth or gums that might have wider implications for health. It's about essentially the same small area of flesh and bone being cut into by two sets of doctors, one of whose costs can be insured against and another whose have to be borne directly. According to one of my several dentists, it's basically pointless to argue with a health insurer about a case like mine. Whether they paid for those first sutures in my broken face or not, if teeth are involved, the second set of sutures are not insured. He's heard of only one patient winning partial reimbursement from a health insurer, after years of trying.

I'm lucky: I had good insurance, a good job, a supportive family. But not having an option for catastrophic dental coverage wiped out my savings. If I were unlucky, it could have completely thrown my life off course.