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Wisdom Teeth conundrum

  • 13-09-2019 12:21pm
    #1
    skinny90
    Registered Users Posts: 2,466 ✭✭✭


    Hi All,

    Sorry for the long post in advance but il keep things brief and simple.

    My old dentist has left so I am now going to a different Clinic.

    I have never had any issues with Wisdom teeth until recently.

    Basically one is growing against another tooth causing my gum to Flap

    If food gets trapped I then go through a couple days of pain.

    So this has brought me togo to the new dentist.

    Issue 1

    Straight away the new dentist mentioned that 2 wisdom teeth will need to be

    removed(top and bottom) and right away said it will not be covered under my insurance. I questioned this as my cover does cover extractions.

    He said it "might" require surgery which is €500

    I asked at what point will we know that this could possibly turn to surgical with a response saying he will not know until the procedure has commenced.

    This puts me precarious position.

    Issue 2
    So I called my dental insurance who confirmed they wont cover this but to check with my health insurance.

    Health insurance will not cover this even if I get referred to a hospital has this is a pre existing condition, In their words, (The wisdom teeth all ready existed)

    Where can I go from here it sounds crazy that they wont cover it due to it being a pre existing condition.

    I should add that there was a break in health insurance for a year (2016) due to a job change

    Any idea how to tackle this?


Comments

  • #2
    ArrBee
    Registered Users Posts: 789 ✭✭✭ArrBee


    I don't have any advice on the paying for it part. other to say, WTF is the point of dental insurance if it doesn't cover dental work. :/
    Just another reason why the insurance industry needs a rocket up the wotsit.

    But I would say I had the same symptom as you and had all 4 removed in a surgical day procedure.
    I am very glad I did it except that an adjacent tooth was damaged during the extractions which went on to cost a bit to fix up.

    You might want to find out who will pay for any damage done during the extraction if it occurs. (surgeon or insurance or you)


  • #3
    punisher5112
    Registered Users Posts: 24,647 ✭✭✭✭punisher5112


    I got one side out for €250 they advised to take top and bottom so the other wouldn't bite into gum or possible to....

    My dental near landsdown rd


  • #4
    dragonfly!
    Registered Users Posts: 1,056 ✭✭✭dragonfly!


    My health insurance covered me to go private apart from the cost of the consultation which was something like €150
    It also DIDNT include the cost of the anesthetic which again is a bit stupid cuz im not gonna have it without.... but anyway!
    Can you look into if thats an option for you?
    In general unless its a simple extraction they wont recommend going to the "normal" dentist anymore due to the risk of nerve damage
    I hope you get sorted quickly. Wisdom teeth issues are zero craic


  • #5
    skinny90
    Registered Users Posts: 2,466 ✭✭✭skinny90


    dragonfly! wrote: »
    My health insurance covered me to go private apart from the cost of the consultation which was something like €150
    It also DIDNT include the cost of the anesthetic which again is a bit stupid cuz im not gonna have it without.... but anyway!
    Can you look into if thats an option for you?
    In general unless its a simple extraction they wont recommend going to the "normal" dentist anymore due to the risk of nerve damage
    I hope you get sorted quickly. Wisdom teeth issues are zero craic

    Hey, Thanks
    It looks to be root I need to go. this is my issue#2 tho, the insurance are using a load of red tape stating this is a pre existing condition.

    Essentially using their logic if, in the future a tumor was found I could be declined cover based on the fact that this could be a pre existing condition which would mean i would have to wait 5 years


  • #6
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    skinny90 wrote: »
    Hi All,

    Sorry for the long post in advance but il keep things brief and simple.

    My old dentist has left so I am now going to a different Clinic.

    I have never had any issues with Wisdom teeth until recently.

    Basically one is growing against another tooth causing my gum to Flap

    If food gets trapped I then go through a couple days of pain.

    So this has brought me togo to the new dentist.

    Issue 1

    Straight away the new dentist mentioned that 2 wisdom teeth will need to be

    removed(top and bottom) and right away said it will not be covered under my insurance. I questioned this as my cover does cover extractions.

    He said it "might" require surgery which is €500

    I asked at what point will we know that this could possibly turn to surgical with a response saying he will not know until the procedure has commenced.

    This puts me precarious position.

    Issue 2
    So I called my dental insurance who confirmed they wont cover this but to check with my health insurance.

    Health insurance will not cover this even if I get referred to a hospital has this is a pre existing condition, In their words, (The wisdom teeth all ready existed)

    Where can I go from here it sounds crazy that they wont cover it due to it being a pre existing condition.

    I should add that there was a break in health insurance for a year (2016) due to a job change

    Any idea how to tackle this?

    Who is saying that this is a preexisting condition? What have you told them about the history if issues with the wisdom teeth? Does your pain and infection predate your cover? Simply having wisdom teeth prior to having insurance does not make it a preexisting condition.... having pain or infection with a wisdom tooth makes it a known or preexisting condition... I've had an appendix my whole life but if it causes issues I'd expect it to be covered.....!

    Dental insurance often does not cover surgical extractions. If your tooth is jammed up against another then is is likely an impacted tooth and a surgical approach is likely indicated.... medical insurance usually covers the removal of impacted or unerupted teeth.....

    A general dentist is often not registered to do these procedure on your medical insurance... an oral surgeon would be registered....


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  • #7
    skinny90
    Registered Users Posts: 2,466 ✭✭✭skinny90


    Oral Surgeon wrote: »
    Who is saying that this is a preexisting condition? What have you told them about the history if issues with the wisdom teeth? Does your pain and infection predate your cover? Simply having wisdom teeth prior to having insurance does not make it a preexisting condition.... having pain or infection with a wisdom tooth makes it a known or preexisting condition... I've had an appendix my whole life but if it causes issues I'd expect it to be covered.....!

    Dental insurance often does not cover surgical extractions. If your tooth is jammed up against another then is is likely an impacted tooth and a surgical approach is likely indicated.... medical insurance usually covers the removal of impacted or unerupted teeth.....

    A general dentist is often not registered to do these procedure on your medical insurance... an oral surgeon would be registered....

    Hey,

    Its Irish Life my health insurer.

    They have no history on me regarding dental treatments

    Even of they did nothing about wisdom teeth issues or pain would be present.

    Yes I am aware of the dental insurance and what is not covered but now in a situation where I do not know where I stand regarding my health insurance.

    Any particular reason why the dentist is not registered to do the procedure.

    They will be doing the procedure after all

    Thanks


  • #8
    btkm8unsl0w5r4
    Closed Accounts Posts: 9,538 ✭✭✭btkm8unsl0w5r4


    If you had a heart attack...is having a heart a preexisting condition....not at all.

    Its only a preexisting condition if you had problems with the wisdom teeth before the start dates of your insurance. They may have asked you a question that lead you into saying that you did, this is why its best leave dealing with insurance to your oral surgeon.


  • #9
    skinny90
    Registered Users Posts: 2,466 ✭✭✭skinny90


    Anaya Few Cloth wrote: »
    If you had a heart attack...is having a heart a preexisting condition....not at all.

    Its only a preexisting condition if you had problems with the wisdom teeth before the start dates of your insurance. They may have asked you a question that lead you into saying that you did, this is why its best leave dealing with insurance to your oral surgeon.

    This is the case, I have not had any issues prior nor have they asked. Once the word wisdom teeth was mentioned it was a pre existing condition.
    Just to clarify the oral surgeon is not my dentist correct?
    I would need to be referred to an oral surgeon?


  • #10
    Oral Surgeon
    Registered Users Posts: 3,240 ✭✭✭Oral Surgeon


    skinny90 wrote: »
    This is the case, I have not had any issues prior nor have they asked. Once the word wisdom teeth was mentioned it was a pre existing condition.
    Just to clarify the oral surgeon is not my dentist correct?
    I would need to be referred to an oral surgeon?

    I would ring the insurer and be very clear;
    for example
    I have been covered with you for 5 years...
    I have had issues with my wisdom teeth in the past 2 years and have been told in the past 6 months that they should be removed
    They are impacted (ie stuck)
    AM I COVERED TO HAVE THIS PROCEDURE DONE AND IF NOT WHY NOT?? ASK WHAT INFORMATION LEADS THEM TO THINK THAT THIS IS PRE-EXISTING??

    General dentists can sometimes be registered with medical insurers but often on a part participating basis where the insurer pays some and the patient pays some of the bill. They often work on the basis of pre approval too where they seek approval from the insurer to cover the procedure...
    DID YOUR DENTIST SEND A PRE APPROVAL FORM ON YOUR BEHALF, IF SO, THIS MAY BE THE REASON WHY THEY THINK ITS PRE EXISTING (IF YOUR DENTIST LISTED AN EARLIER DATE FOR THE START OF SYMPTOMS)
    Oral surgeons are usually registered on a fully participating basis where certain procedures are paid in full to them and the patient dose not need to pay more specifically for that job. We also don't need to seek pre-approval to do the procedure and can send the invoice after the procedure is done.....


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