Thursday, January 8, 2009

Corn on the Cob Through a Picket Fence

Maybe your kids aren't costing you enough money. If so, I recommend sitting down with your child's dentist for an orthodontic consult. I did this yesterday, and he said that Laura has a crossbite, and needs a palate expander to widen her upper jaw. When she closes her teeth, it's like trying to put a tupperware lid on a bowl that it's too small for--you can get one side closed but not the other. So her teeth overlap and her jaw moves to the side.

I didn't have to be convinced that she has a crossbite. You can see it in pictures of her. Look at how one of her front teeth is behind the lower teeth--her bite is wonky. Now that I look at this, it seems like her chin juts a little to the side.

She is not yet 8, so there is plenty of time to expand her upper jaw using a palate expander, which the dentist called an RPE, or rapid palatal expander. It's a little appliance that goes up in the roof of her mouth, attached to her teeth, that we turn with a key every day. This goes on for 6 months or so and costs $1500. I questioned him thoroughly about it, and he doesn't think she will need any braces at this point--just that the crossbite needs to be fixed to prevent future tooth and jaw problems. It seemed to me like a moderate approach. That said, I don't really want to change this beautiful face, and I hope the palate expander won't make her face look different. Has anyone been down this road?

So we are lucky enough to have some orthodontic coverage as part of our dental insurance, but it's a lifetime max of $1000. I think that's pretty standard. Here's where the whole insurance game gets tricky. Dentist guy said that if he bills them the $1500 for the palate expander and all the appointments that come with it, they will pay $750, leaving us to pay the other $750 out of pocket. But if he bills them $3000 for "Phase I Treatment," which includes the palate expander and any braces that came right afterwards, he could "capture" the whole $1000, leaving us to pay just $500 out of pocket. The HMO doesn't care how much he bills, 'cause they're only in for the first $1000. I was like, um, why don't we do that then? That is some serious strategery.

And strategery is what is needed in dealing with these health insurance people. I won't name names, but their initials are Humana. They're all very nice, or at least the people you actually talk to are, but I think the actual business operations must be handled by insane weasels. I am locked in a life and death struggle with them right now over a flexible spending account reimbursment. You know, flexible spending accounts? Where you give them YOUR money before taxes, and then ask for some back to pay for medical or dental expenses? Only they aren't happy with the documentation you give them, because they think that maybe that check you wrote at the dentist wasn't used to pay for dental services? And I'm like, "What other kind of service could there be at the dentist? A mani-pedi?" But don't get me started. And no worries, I will prevail.

So that is the news from our checking account. And Matt is getting LASIK tomorrow morning--on both eyes no less. Hey big spender! So I am reliving my childhood, in which both of my siblings got expensive orthodontia and I didn't need it, for which I still think my parents owe me $5000. It's only fair, RIGHT? And I'm being penalized for having perfect vision too! I think I need a new diamond ring, because WHERE IS MY EXPENSIVE THING THAT'S CUT WITH LASERS??


Kelly said...

I didn't have to have a palate expander but it took four years of braces and some ridiculous head gear to get my mouth in shape. I swear my teeth weren't that out of whack!! I still have a permanent retainer that is cemented to my bottom teeth. My friend had an RPE and it's a bit painful to get used to but now she has a beautiful smile!

Bren said...

I'm having nightmares. I don't even want to hear the word "orthodontics".

We're in the middle of deciding which spouse loses the arm and which gives up the leg for our dentist at the moment.

Kate said...

Somehow I escaped childhood without braces or a palate expander. Now that having perfectly straight teeth is the norm, I wish I would have done my time. Laura will thank you one day!

Oh, and your logic behind the diamond ring is totally air tight. It's time!

Casey said...

Ha, both of my brothers got braces and I didn't need them. They suck.

Sorry to hear about the huge bills headed your way. That is some tricky dentistry! I've never heard of a cross bite... I hope the treatment isn't painful.
Our FSA has been pretty good unless we fail to give them a detailed summary of the services. Screw them. Good luck with the insurance company!

Michele said...

OK, this is right up my alley on many levels. I have been in the group benefits arena for 20 years....and am about to tackle my children’s first ortho visit…..I will send you separate comments to break this down. Laura is adorable and I wouldn’t want to change much either. Has anyone met an ortho who couldn’t find a needed appliance or bite or alignment issue? They’d probably find a reason to treat Britney Spears if she walked in. I have 12 and 10 yr old boys who’ve both just now lost their last baby teeth. Their teeth are pretty much perfect IMO which is why no ortho consult until this year. One has some lower crowding. I am sure I’ll be hearing they both need braces. Then there’s my 8 yr. old son. He’s in 2nd grade and has a narrow palate and major crowding. The ortho will have a field day. He is no where as bad as my friend when we were in 7th grade (when kids used to first go to the ortho). She started at age 12 with the palate spacer thing and then braces.
Question—Did you say the ortho office is an HMO in that you have to go to a list of orthos who’ve contracted with the insurance provider? Or do you go to any ortho you want?
--Michele in Atlanta (more to follow)

Amy said...

I had to have one of those palate thingys, as I'm sure you remember! (then braces, then jaw surgery--dear Lord. of course, it DID serve to help make me the gorgeous creature you see today.) Ava has a cross bite as well, so I see that looming in our future. Good times!

As for the diamond ring, you are so right. Or maybe if you got LASIK on 20/20 vision, it would give you some kind of magical xray vision--that would be cool.

Becky said...

Michele, yes, it's an HMO-contracted guy. After she has the panoramic x-ray thingie and impressions made, he's going to make his "official" recommendation, which could just be the RPE but could be more--he just said he doesn't see anything right off the bat.

Also, I don't really think everyone who works for an insurer is an insane weasel! ;) I used to be one of them myself.

Keely said...

"insane weasels", hahhhahhahha! I got a fantastic visual there.

Sara said...

Laughing at your title.

It seems so young to be starting on all this orthodontia, but I guess it makes it easier when they're younger? I'm sure L's grin will remain perfectly cute, and I agree with Kelly that she'll probably thank you later on.

And small world--what thrilling insurance job did you have? I think they also have circus bears running things in addition to the weasels. Passive aggressive circus bears.

Jenni said...

Oscar's already got a crooked grill, so I'm sure we'll be in for a couple grand. sigh.

Better Than Machines said...

I am an orthodontic tragedy. I had a palate expander, when I was five I think. Braces later on. Then I didn't really wear my retainer so my teeth went crooked again. Now I go around telling my story in orthodontist's waiting rooms, warning, "Don't turn out like me, kid!"

With the palate expander, once I got used to it, I just thought it was cool that something in my mouth required a key.

Veronica said...


Minnesota Matron said...

Ouch! Yes - you sure can see that little switch to her chin. Do you have a dental school? We have the University of Minnesota where the dental school sees children for about 3/4 to half of the rate AND takes health insurance. All work is overseen by real dentists - professors, the best in their field. That's where we're taking our little money vacuums.

Cassie said...

I had a cross-bite also. I wasn't nearly as cute as Laura, though. I didn't need The Crank (my cousin had one); just regular ol' braces... a few different times.

And Lordy, don't even get me started on insurance companies and FSAs. Every week is a new battle around these parts. Hang tough, dude.

I hope Matt's Lasik went well!

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