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Dentistry as a Privilege? (primarily US)

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marynyc

Member
Joined
Aug 7, 2018
Messages
57
In all the help I've received from the kind people here, and being lucky enough to find a good, competent dentist that is working with me, I can't help but think about dentistry as a privilege. In the US, almost all healthcare is a privilege that is directly related to class and income. Pain free healthcare, mental health care to deal with anxiety, etc. is often reserved for those who can afford it.

My traumatic dental experience primarily stemmed from seeing a dentist I could afford, not a good dentist. Here in NYC, low-income people often resort to NYU or Columbia dental schools, where their anxiety isn't a priority, and student learning is ultimate, over their comfort. They never get the chance to overcome their fears, because their only option doesn't prioritize it and sedation (of any kind) adds to the cost.

In the US, even those with dental insurance can't get GA or IV sedation unless the costs are covered under medical (wisdom tooth extraction for example, falls under this for many health insurance plans, vs. dental plans). Everyone else, has to suffer through with LA injections - even nitrous is extra and not covered by most insurance plans because it's considered unnecessary to complete work - regardless of your anxiety level.

I envy those of you in the UK - although the wait times to be seen would probably send me over the edge, as l already have a hard time with all of my appointments being spread out over a month - but at least you're not generally at risk of going bankrupt or having to choose between paying for care and being homeless.

Even those of us with insurance, have to pay up-front for anything not covered. I was caught off guard after my root canal on Monday - JUST the root canal, my out of pocket was $281. Which isn't much, for the US, but had my husband not been with me, I would have honestly been in a real bind. They hadn't given me a treatment plan in advance (their oversight) so I had no idea. If we weren't incredibly lucky and privileged, I'd have to space out essential treatment even more, just to save up in between to pay for it. I am already having to consider postponing some fillings until January because this *one* tooth root canal + post + crown, will hit my yearly max of $1500. I had it suggested to me that I get an implant for the extraction I had 5 years ago, and that sounds great and all, but who is going to pay for a $2,000 implant for a single tooth?

So what do we tell people who have pain, decay, infection, who are already scared and ready to take care of things and face their fears, when they just don't have the money? Even a single extraction at the Columbia Dental School costs $80 in exam fee and $95 for the procedure. That's $175 to extract a single tooth.

I know this is sort of deep, but I find trying to approach things intellectually, can often help my anxiety, so if I have another topic to focus on/chat about, it can help.

If anyone here is in the US or a similar situation outside the US, how have you handled much needed, necessary, vital, treatment, on a budget? CareCredit? Loans? Just curious to start a discussion and didn't see anything more recent on the forums that was similar to this topic.
 
FearfulInMA

FearfulInMA

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Jun 14, 2012
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2,193
Location
Massachusetts, USA
I’m in the US in a major city. When I started back going to the dentist about 10 years ago, I was making very little money (despite working 2 jobs and having a masters degree). I put some of the cost on credit cards and some I paid bits and pieces as I went along. Luckily, at that point, I only needed a lot of fillings and my wisdom teeth out (which was paid for by medical insurance b/c they were fully impacted). Because I’ve continued to need dental work done over the years - and have had to have more major work done - I put money in a medical flex spending acct every year through work. That had really helped a lot b/c the money is taken out pre-tax.

I completely agree with you about dental care being a privilege here in the US - I know so many people who have not been able to afford even the most essential dental treatment. It’s not ok that it’s not a right here.
 
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marynyc

Member
Joined
Aug 7, 2018
Messages
57
I’m in the US in a major city. When I started back going to the dentist about 10 years ago, I was making very little money (despite working 2 jobs and having a masters degree). I put some of the cost on credit cards and some I paid bits and pieces as I went along. Luckily, at that point, I only needed a lot of fillings and my wisdom teeth out (which was paid for by medical insurance b/c they were fully impacted). Because I’ve continued to need dental work done over the years - and have had to have more major work done - I put money in a medical flex spending acct every year through work. That had really helped a lot b/c the money is taken out pre-tax.

I completely agree with you about dental care being a privilege here in the US - I know so many people who have not been able to afford even the most essential dental treatment. It’s not ok that it’s not a right here.
So true. I live in a major city (NYC obviously lol) and my husband and I both work in higher ed and though we truly have excellent insurance coverage, for what most is, it's still so limiting.

My job doesn't offer an FSA but his does, so we'll be using the funds from that to cover the difference. Otherwise, we'd be choosing between my dental work and not visiting family abroad for another year in a row. If I was single, my own jobs coverage would cover quite a bit, but as an HMO the doctor options are limited and the majority of them that tend to see low-income patients aren't necessarily the best (this has been my experience with both dentistry and medical, before I graduated and "married up" as they say).

I'm really glad you have the FSA option now - my pre-tax deductions are so convenient.
 
FearfulInMA

FearfulInMA

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Massachusetts, USA
I’ve had a lot of jobs over the years but have been fortunate to always have an FSA option. My husband works for a fortune 100 company that is likely the largest healthcare company in the country (or certainly one of the largest) and he only had a high-deductible plan option. Before he met me he had only been to a doctor a couple of times in the 10 years prior. It’s crazy to me that he can work for such a large and wealthy healthcare company with such awful insurance coverage.
 
Dg6300

Dg6300

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Joined
Oct 27, 2017
Messages
636
Location
US
Agreed!

I have been on both sides, and appreciate my employer provided dental benefits a great deal.

Having no dental care for ten years (retail working poverty), I am astonished at the privilege heaped on me (dentist, periodontist, oral surgeon) just because I now have a plastic card in my wallet. When I was working poor in America, no cared at all about my dental health.
 
krlovesherkids777

krlovesherkids777

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Jul 26, 2017
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2,927
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Minneapolis, MN
I've had problems too,, with this being a single mom with very limited budget for dental but needing alot more than I can afford,, then you tend to do "damage control".. just wait until something goes bad, instead of preventative treatment so something bad doesn't happen. Its really too bad.. When I found my dentist I have now I asked the clinic if I could do like a "Layaway plan".. so I would just give them money whenever I could, 100 here , 200 there, etc, to build up and when i had enough for something I would do that. It helped me pay what I could to get some work done

Also I know Groupon has deals and some good prices, of course urge everyone to check out reviews and information before they buy the groupon. They may not all be anxiety patient friendly. but it is a less expensive option sometime.

I have tried a few sliding fee scale places over 20 years ago but didn't have great experiences there , waiting all day for minimal care or to be sent home.. although it totally depends who you get.. but usually not much choice in that type of setting.
 
Judythecat

Judythecat

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Joined
Mar 7, 2018
Messages
613
I live in Scotland, and while we do have the NHS, treatment is still very expensive. I am lucky enough to have a good NHS dentist, but what the NHS actually covers is securing dental health - essentially meaning that you are not in pain and you are able to eat. It’s not free to have treatment, although two checkups a year are. It’s considered a huge benefit to have private health care through work, and most people don’t. Even if you do, dental isn’t usually included in the plan.

Implants cost around the same as in the US, for example, and are only available privately. I recently needed root canals on two upper molars which my own dentist thought might be too complicated for her to do (very long, twisted roots) so seeing an endodontist cost £2,000, then crowns at an additional cost. My own dentist would have had a go at them, but if the treatment wasn’t successful the teeth would - under the NHS - have been extracted because they are at the back and not visible, and I have other teeth I can eat with.

The NHS provides free medical (not dental) care for everyone, which is amazing, but it is under huge pressure, lacks funding, and waiting times are massive. In many cases, those who can afford it will pay to go privately. (As an example, my friend recently had gynae surgery. She had been on an NHS list, in severe pain, for 18 months. Last month she paid - £6,000 - to have the procedure privately, because she couldn’t wait any longer in such pain. She was able to do this because her mother passed away and she inherited money.)

I think the U.K. system is moving closer to the US all the time. I feel very fortunate to have a great NHS dentist, and to be able to fund private/specialist treatment if I need it. Many here are absolutely not in this position!
 
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mcredding

Member
Joined
Aug 29, 2018
Messages
43
Location
San Francisco Bay Area
The US, despite being one of the most developed countries in the world, is by far the worst in terms of healthcare disparities. Why?
  • Corrupt politicians simply don't care.
  • US voters are notoriously adamant about healthcare reform. We all complain about the high cost of care, but when push comes to shove, the vast majority of people here in our country will actively work against themselves: We only elect people from parties that see nothing wrong with the massive disparities, & every single time anyone--in government or not--proposes a solution, we, the people, protest en masse against it. Basically, dentistry is a privilege because the majority of people support treating it like a privilege.
  • Insurance companies and providers actively fight any attempt to treat dentistry like other medical conditions. Whether they want to admit or not, just like the insurance companies, the American Dental Association & similar organizations actively fight any attempt to increase regulation or lower costs. Am I saying all dentists are bad? No. But it doesn't exactly help the situation when bad apples actively work to keep dental care beyond the reach of the poor.

As to what we can tell people who can't afford care--well, unfortunately, there's not much you can tell them. Because of the issues I've mentioned, the poor are essentially condemned to live a life of pain, & you can be sure that no doctor will help them with pain management for it.
 
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MountainMama

Well-known member
Joined
Jul 1, 2018
Messages
2,209
Dental health insurance has not been helpful for us in the U.S. We pay $1500 a year, with a $1500 cap (procedures are covered at 50%). So we are basically paying now for something that "might" happen later. Preventative care is covered 100%, but if you pay your monthly fees and only need preventative care, you essentially lose money.
This year, we were doing okay financially. We bought a house, and I was working part time (I have always worked full time), with my husband working full time. We live in a fairly rural area. Then we had a series of dental issues come up with myself, and my daughter had teeth that were impacted and needed removing. All of a sudden we were in debt and it keeps piling up. I have to find a full time job, and our Christmas plans to travel to see family are cancelled. We are having to use our credit card because we wiped out our savings. We don't qualify to go to any of the dental clinics or receive assistance, which I completely understand, but we are now struggling to pay bills.
 
Sevena

Sevena

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Joined
Jun 24, 2012
Messages
834
Location
UK
I currently live in a country in Scandinavia (not the UK at the moment) with very good socialised healthcare, but dentistry is not socialised and the costs are quite high. I don't think they are quite as high as in the US, but they are high enough that many people I know will put off dental work until something goes wrong, as they don't want the added expense.

The UK was much better in that regard, as you could get subsidised dental work, if not free. That said, for many people making an okay wage but struggling with mortgage and other bills, it still remained a last resort.

It makes me furious. Teeth are a part of our bodies, they should be covered just the same. Of course, in the US, healthcare coverage is woefully lacking, and I feel awful for all my American friends.

It's a real injustice that people have to tackle scary health problems and treatments while worrying about money and bankruptcy.
 
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MountainMama

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Joined
Jul 1, 2018
Messages
2,209
I currently live in a country in Scandinavia (not the UK at the moment) with very good socialised healthcare, but dentistry is not socialised and the costs are quite high. I don't think they are quite as high as in the US, but they are high enough that many people I know will put off dental work until something goes wrong, as they don't want the added expense.

The UK was much better in that regard, as you could get subsidised dental work, if not free. That said, for many people making an okay wage but struggling with mortgage and other bills, it still remained a last resort.

It makes me furious. Teeth are a part of our bodies, they should be covered just the same. Of course, in the US, healthcare coverage is woefully lacking, and I feel awful for all my American friends.

It's a real injustice that people have to tackle scary health problems and treatments while worrying about money and bankruptcy.
I agree that dental should be included in healthcare. It would make it easier to meet the high deductible for health insurance for one thing. Plus, dental issues cause health issues, and people miss work for dental issues. My dental problems this summer had me taking ibuprofen, which causes an ulcer. They also caused chronic sinusitis. I had to go to the different doctors to get those issues treated, with different insurance. It is crazy. The dental insurance is capped at $1500, while one root canal cost $1650 here. Not including the crown. Then health insurance has a $6000 deductible you have to meet before they cover anything. I have paid out $6000 in dental bills this year alone between my husband, daughter and me. Yet that doesn't count toward our deductible. It is insane.
 
G

geos

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Joined
Dec 22, 2011
Messages
503
Location
Ottawa, Ontario, Canada
I'm in Canada. While we have the free healthcare, that doesn't cover dental or optical. At the same time there are many studies that link eye and teeth health with our general health. I'm lucky enough that I made enough money to pay for dental work with no help from dental insurance for the first 9 years of my working life and now I have some dental coverage, which is far from great. Luckily it seems that there is some political willingness to improve the access to basic dental care here, but it sounds that we are still far from it.

I find it sad when I see dentists say they are generous because they go spend a few weeks in under develop countries to provide dental care, while people in their own country can't access dental care.
 
F

fierybear

Junior member
Joined
Mar 28, 2019
Messages
2
Location
United States
As someone in the United States, how do I deal with it? Simple. I don't. I deal with the pain because I don't have any other option. I'm a single female so I don't qualify for financial assistance or most programs. Living in a rural area also limits my ability to go to a place where I could afford it. I can't afford insurance either. It is a privilege that I don't have and my anxiety with it is through the roof.
 
kitkat

kitkat

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Mar 27, 2006
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I have always had decent dental insurance premiums offered through work but I have spent an abundance on the actual work. Recently, at least with my current dental plan it seems to really matter what kind of filling you get and you are charged extra for a white filling versus a silver one. I remember my root canal cost $100 out of pocket (but they billed the insurance like $1000!) and then I paid I think almost $800 for the crown and the insurance was billed like $1300 or $1600...I can’t remember exactly but the numbers really blew my mind. That would be over 2k out of pocket on one tooth if I had not had dental insurance and even with insurance, it was almost $1000. I had to charge it on a credit card and pay it off over time.
 
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MountainMama

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Jul 1, 2018
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I have always had decent dental insurance premiums offered through work but I have spent an abundance on the actual work. Recently, at least with my current dental plan it seems to really matter what kind of filling you get and you are charged extra for a white filling versus a silver one. I remember my root canal cost $100 out of pocket (but they billed the insurance like $1000!) and then I paid I think almost $800 for the crown and the insurance was billed like $1300 or $1600...I can’t remember exactly but the numbers really blew my mind. That would be over 2k out of pocket on one tooth if I had not had dental insurance and even with insurance, it was almost $1000. I had to charge it on a credit card and pay it off over time.
The credit card was the only way we have made it with my recent dental issues. Our insurance caps at $1500, and we pay half out of pocket. One root canal costs $1800, so we pay $900. A crown costs $1500, so we pay $759. Extractions cost $750 at the oral surgeon, and most dentists in this area will not extract molars with twisty roots. I had two root canals, two extractions, two apicoectomies ($1800 each), and still need three crowns. The cap for insurance was reached long ago for the year, so everything is out of pocket and full price. Hence the credit card. We don't have that kind of money. It is astounding how much dental care costs.
 
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