“The only way to get through life is to laugh your way through it. You either have to laugh or cry. I prefer to laugh. Crying gives me a headache.” ~ Marjorie Pay Hinckley
My youngest son, Joseph, has been seeing an orthodontist from the time he was six years old. (By the way, I am choosing to leave the names of the orthodontists and oral surgeons out of this post, as I am not sure if we are going to sue or not. Personally, I rather not. I just don't have the strength). However, Joseph, from the time he was a toddler, was a thumb sucker. Actually, he was more of a finger chewer, which at least two, if not three fingers in his mouth. His dentist was concerned if this continued, he would end up with a severe overbite and other problems. So he referred us to an orthodontist in Olympia. When we first met Dr. T., we thought he was charming and very personable. He fitted Joseph with a hay rake. What I thought looked like a medieval torture device. A hay rake is a mechanical device where wires attached to the rear molars then extend to the front of the mouth. The device has spikes just behind the front teeth and is intended to cause discomfort when the thumb or fingers are inserted. Basically, the sharp prongs hurt the thumb, and this stops the patient from thumb sucking. Joseph had permanently stopped sticking his fingers in his mouth a few months after Dr. T fitted him with the hay rake.
Not long after, Joseph started seeing Dr. T. annually to check the progress of his mouth, jaw, and teeth. Joseph was also a nighttime teeth grinder, so Dr. T. put these little glue dots on the back of his molars, in hopes Joseph would grind on the dots and not his molars. Over the years, we devolved a good rapport with Dr. T., as he became both Michael and Steffen's orthodontist, too. I really appreciated the patience he displayed with Michael, who is ADHD and suffers from severe anxiety. Not once did I ever feel uncomfortable coming to the office and he always took time to answer questions and give advice.
Fast forward a few years later, and now it was time for Joseph to start orthodontia. We dragged our feet a little bit, as I really did not want to be paying for two kids in braces at the same time. When we only had a few payments left for Steffen's braces, we started Joseph. We believed things were progressing well, but then Dr. T. asked if he could schedule a consultation visit with us. At this meeting, he discussed with us that Joseph was going to need additional care and more than just braces. He would need a mandibular osteotomy. This did not come as a total surprise, as I had this same procedure done when I was his age. Basically, while a patient is under anesthesia, an oral surgeon breaks the lower jaw and it’s then positioned forward and fixed into place with plates and screws. When I had my surgery, the doctor broke the upper and lower jaw and my mouth was wired shut for six weeks.
He referred us to Dr. B.in Seattle. On his scheduled visit with the doctor, Dr. B. agreed with Dr. T. that Joseph needed this surgery. He then told us we needed to have Joseph’s wisdom teeth extracted at least six months before his jaw surgery. Then his office sent a pre-authorization letter to our insurance company, Group Health Cooperative. GHC denied the surgery, stating, basically it was cosmic surgery and not medically necessary. Unreal. A mandibular osteotomy is done to prevent later issues with TMJ and sleep apnea. And patients with malposition of the jaw have difficulty with eating and speech. And Joseph’s is serve, but it’s not medically necessary. We asked for an appeal, but didn’t get anywhere (No more Group Health Cooperative for us), so when open enrollment came around in November, we shopped insurance companies. We discovered only two companies, out of the several offered, covered mandibular osteotomy, and only if it was medically necessary. No, we just want to break our son’s jaw for giggles. I mean really. We choose Blue Cross/Blue Shield as our medical provider for the year and kept Government Employees Health Association (GEHA) as our dental insurer. After the new insurance took effect, we asked Dr. B.’s office to send a pre-authorization letter. A few months later, we received notification from Blue Cross/Blue Shield the surgery would be covered. About a month later, we received an estimate from the doctor and we were confused. The bill included other fees and then underneath it read, “There is no cover available under your medical or dental policy. This fee is considered patient responsibly.” Now, this is not deductibles, premiums, or co-pays, this is purely out of pocket, and was $3066. “What?” we asked. The billing office was incredibly rude and unprofessional when we asked for the billing code, so we could verify with our insurance company. And all she told us was no insurance companies cover the work-up. Anyway, got so frustrated with them, we decided to seek a second option and possibly a different doctor.
This is where the fun really began. We then tried to take care of Joseph’s wisdom teeth. We learned Joseph does not have four wisdom teeth, he has six. Yes, you read that right. . . six! We were quoted close to $3000, and even though our insurance covers 80% for extraction, that’s still a lot of dough. Therefore, we thought we would get a second estimate. Dr. T. referred us to an oral surgeon in Olympia. We were charged $85 for the office visit, even though I found out later from our insurance company we should have only had an $25 co-pay for the office visit. When I went to the office and complained, I was practically thrown out on my ear. And told I didn’t know what I was talking about. Therefore, I complained to our insurance company, warning them about the shady practices of this office. Moral of this story, don’t tell me I am wrong. Supposedly, I have been issued a refund. Waiting to see if it comes in the mail. Again, we were quoted something in the thousands for Joseph’s wisdom teeth extraction, including sedation (which we later learned even though we have high option dental insurance, sedation is only covered at 30%). We decided, Joseph would only have his bottom teeth extracted, as those were the ones that HAD to be extracted before surgery. The other four can be extracted during the mandibular osteotomy, where I am sure sedation would be covered at 100%.
With the extraction of Joseph’s wisdom teeth and Dr. T. insistence that Joseph needed the surgery sooner than later, we began to shop around for another oral surgeon. Because Joseph was a minor, no oral surgeon would talk to us without a referral. And Dr. T. wanted to know why we were not happy with Dr. B. Sorry, no one’s business. We first tried Seattle Children’s Hospital, but was told it would be several months out before he could even be seen for a consultation visit. Next, we tried University of Washington Oral and Maxillofacial Clinic. They agreed to review his case, but asked why we were not using Dr. B. Honestly, what business is it of theirs? So much from patient-doctor confidently. We sent up an appointment to see Dr. D. He seemed pleasant enough. He agreed Joseph needed the surgery, but wanted to wait until the summer, when he was not in school and would have the time off to recuperate. Patients need six weeks to heal, and four weeks of liquid and soft foods diet. Joseph is going to waste away to nothing! I remember eating nothing but milkshakes for about six weeks. My mom mixed some foods for me in the blender, but there is not much worse than eating macaroni and cheese or mashed potatoes that has been pureed.
Dr. D. then told us he needed x-rays and models of Joseph’s mouth and then several weeks before the procedure, he meets with oral and maxillary consulates to discuss the case, and guess what; Dr. B was one of the consulates. Ugh, I feel we just can’t get away from him. In addition, we were informed, he would make a model now and another one right before his surgery just in case he had grown. Well, of course he will have grown, he only just turned 16 and has been growing like a weed. He’s now over 6’2”. He informed us each of these work-ups would be $875 (x2) and was not covered by insurance. If this is standard operating procedure, why is it not covered by insurance? Are you freaking kidding me? So when we talked with the billing office later that morning, again, I asked for a billing code. She said she would get back to us, three months later, she has not. And I have left two voice mail messages and an email. No reply.
Having us over a barrel, we agreed to the first orthognathic work up, which was scheduled for early October. However, back in August, Joseph had a check-up appointment with his dentist, which requires a visit to the orthodontist to remove the wires, so his teeth can be cleaned, and then a trip back to the orthodontist to put the wires back on. We had no problem getting the wire off, but when I sent my parents with Joseph (because I had an appointment that day), they were told the office was closed and sent them to another orthodontist to put the wires back on. I thought it was strange, but rationalized everyone has off days, and maybe he had a family emergency. It wasn’t until a few weeks later that I learned Dr. T. had been arrested for assault. I am not going to fuel speculation, because there is enough of that on Facebook; however, what I do know is he closed up his business and locked the gate to the entrance of his building. Literary, you could have knocked me over with a feather. Dr. T. was always polite, well-mannered, soft spoken (I don’t know how many times I had to ask him to repeat things to me, because I could not hear him). He showed patience with both Michael and Joseph and was very encouraging to Steffen and his accomplishments. Maybe, he had an off day. Again, I am not going to speculate as we did not witness that argument he had with his office manager. However, what we do know is he left us in a real pickle. Here Joseph was supposed to be starting pre-operative preparations (different brackets, rubber bands, etc.) before his surgery and the oral surgeon works in conjunction with the orthodontist in preparing for said surgery. In addition, for six months following the procedure the patient has regular orthodontist appointments for tightening orthodontia, and watching for movement. The most frustrating part is we paid $3080 to Dr. T. over the past 30-months and our dental insurance company paid him another $2500. We are now out everything we have paid him, and our insurance company was less then helpful, when they told us Joseph has reached his maximum lifetime benefit. However, we would be happy to know, they had paid Dr. T. in full. “Why would this make me happy?” I thought.
First, we cancelled the appointment with Dr. D. as I did not see any reason to go forward with Joseph’s surgery until all the players were in place. Second, I asked for recommendations for a good orthodontist. One name came up more than anyone else, Dr. L. I scheduled an appointment with Dr. L. to see Joseph. He didn’t charge us anything for the consolation, and after taking some x-rays and examining Joseph; he questioned why we were in a rush to do the surgery? He then suggested we wait until Joseph was done growing in two, maybe three years. Then go ahead with the surgery. I believe this is the only silver lining in this whole disastrous experience. I never understood the rush either, but also knew Joseph would be in braces until the surgery or he would be facing a phase two. Nonetheless, we paid Dr. L. $750 to remove Joseph’s braces and for the cost of his retainer. This we had already paid to Dr. T. In addition, down the road, Joseph will have to go back to wearing braces a few months before the surgery and at least six months following the procedure. Dr. L. only gave me a verbal estimate of around $4500. And of course, dental insurance will cover nothing. Super, super frustrating.
I filed a complaint with the Washington State Department of Health, but don’t expect anything to come of it. I also talked with an attorney, he of course said we had a case, but I don’t have any money to pay an attorney. We also talked about taking Dr. T. to small claims court, but he is moving out of the state later this week. I did see Dr. T. yesterday at his office. The office has been stripped of everything and he looked like hell. However, I was able to get a copy of Joseph’s medical records, but not Steffen’s. Now, I am not sure why he did not give me Steffen’s, maybe because Steffen is now an adult or he feels because Steffen is “done” he didn’t need to hand them over. Yes, Steffen is out of braces, but has been in a retainer for less than a year, and Dr. T. only has seen him twice for retainer checks. He missed Steffen’s last check. And the patient is supposed to have regular checks for the first two years. Thank goodness Dr. L. was willing to see Steffen last week and he tightened the retainer, and charged us nothing. Thanks, Dr. L.
Then over the summer while Steffen was working at the YMCA camp, he began to have extreme mouth pain. I scheduled an emergency dental appointment with his dentist. They determined it was his wisdom teeth erupting. They took a series of x-rays and wrote a referral to University of Washington School of Dentistry. They also forwarded the x-rays to the oral surgeon’s office. A few weeks later, Steffen visited the UW clinic, and even though the had his x-rays (they told him his x-rays were too old) they took another set. Unfreaking believable! So now we are on the hook for $368 just in x-rays between the two offices. I swear it’s a conspiracy. These dental offices are in cahoots with each other. We then received an estimate for his extractions. Again, it was over $2500, that works out to $612 a tooth. Highway robbery! With our insurance it would be $489.60 for our cost, which I thought was not so bad, but then added a $96 facility charge. Double ugh! I don’t have it. We just paid Joseph’s orthodontist $750. And of course, Steffen’s wisdom teeth must come out now. (They are coming in crooked). Sigh.
Last week, Joseph had an appointment with his dentist to take care of a couple small cavities (between the teeth – so hard to brush and floss with braces on). I was chatting with the office personal and asked if there was someone more reasonable for wisdom teeth extraction. She asked, “Don’t you have Applecare?” Applecare is Washington state’s Medicaid. “No Daring, some of us work to pay for those who pay nothing for free dental care,” is what I was thinking. I shook my head. “We have private insurance and I think $612 dollars per tooth is outrageous. She then had the gall to tell me, “that’s not bad.” Not bad? What the heck? If we were on state aid, it would be free. This is why I continue to be upset. I honestly feel, as middle class tax payers, we are on the hook for not only paying for our children’s dental procedures, but believe we are also being charged twice as much so doctors and dentists can recoup what they have lost.
It’s a conspiracy!