Shouldn't Health Insurance Cover Teeth?

by Conor Friedersdorf

This is a remarkable story from a reader:

You’re absolutely right about eyes and teeth being critical body parts. And it gets worse than just tooth pain – as you may remember, in 2007 a 12 year old boy named Deamonte Driver died of a brain infection caused by an untreated tooth infection.

I’ve had my own struggles with the dental health care system, though nowhere near as dire or heartbreaking. In 2006, at age 26 and just out of school, I was diagnosed with a rare jaw tumor called ameloblastoma. I had health insurance at the time, but because the tumor happened to be in my jaw, most of my treatment was considered dental rather than medical. A few months later I found myself with tens of thousands of dollars of debt, and a surgeon who stopped providing follow-up care (or returning my calls) when I was unable to pay her.

I spent the next few years trying to find a way to obtain the tooth implants I needed to replace the teeth I’d lost and, more importantly, secure my bone graft. I spent hundreds of hours making phone calls and chasing down leads, none of which worked out. Along the way, I even picked up dental insurance – but it considered the work I needed to be medical in nature, just like my medical insurance considered it to be dental in nature. Finally, in 2009, my bone graft had degraded to the extent that I needed to have a third one done to augment the remaining bone – so, thanks to an insurance policy loophole stating that they wouldn’t disclose my coverage for the procedure until after it had been done, and a masterful doctor, I was able to have both the bone graft and the implant bases taken care of in a single, six-hour surgery. It was an enormous relief. However, it also added several thousand more dollars to my debt.
And I still needed the teeth themselves – without them, I’d lose the top teeth on my left side as well before too long. So it was off for another year and a half of fruitless calling, haggling, sweet-talking, chasing, and begging. Then in July of 2010, my grandfather died. I received a small inheritance from him, enough to cover two things: my teeth, and a bankruptcy attorney. I’m scheduled to have the teeth affixed on February 11.
For want of a 50% deposit of $3500 in February 2007, as of February 11, 2011, I will have received approximately $41,000 worth of care from the health care system. That’s not counting the tens of thousands of dollars of tumor-generated debt prior to that date. Much of that will be liquidated in bankruptcy -- I’ve been waiting to declare bankruptcy for over four years, but it would have been highly unwise to do so prior to the completion of my oral reconstruction. Before too long, if all goes well, I will finally be able to marry the extraordinary, amazing man who’s been by my side through this whole thing, ever since I was diagnosed with ameloblastoma a mere month after we’d moved in together.
To reiterate: I’ve had health insurance this whole time. I’ve had dental insurance since January 2009. But because the systems are split, they each get to point at each other and say “Not my job – theirs.”

I’m wondering – are there any readers out there who have had similar experiences? Has anybody found themselves falling through the bizarre, seemingly arbitrary cracks of our eye care system?