Pricing Health Care

[BigRed]

First post.  I'm a low-level mustachian, we're a one car family of 3.5 on the westside in Los Angeles, and I've been biking to work for 2 years now.  We're slowly building our stache, even with my wife in graduate school and with one kid and one on the way.

My question is, how do mustachians treat health care costs/shopping?  My wife called me cheap for even mentioning cost in a discussion of what to do for our 3 yo.  His dentist found 2 cavities and wants to give him IV sedation to fill them.  The bill will be $1100+ for the anasthesiologist and another $300+ for the dentist.  I'm nervous about sedating a 3 yo for cavities and can't imagine a world in which treating a 3 yo for dental work should cost this much.

Health care pricing is so opaque and ridiculous and the stigma against even considering cost is so high, I'm wondering what mustachians do.  Especially since the mustachian thing is to have a high deductible plan and pay out of pocket.  Do you shop around?  Do you negotiate price?  How do you do it?  How do you discuss price and health care with a spouse who feels price shouldn't be a part of it.

[Bettis]

Sorry I don't have an answer but I totally second this question.  For my case it's animal care rather than children but even when I hurt my knee playing football, doctors only seemed interested in upselling me on more and more tests until I said F it and started doing yoga(which has worked 80-90%).

Don't mean to derail the conversation before it gets going but it's very tricky with health.  One side will say get everything you can done or else you're awful, cheap, and inhumane but health care is so murky that how can you not be a cynic when you usually can't find out how much things cost until it's too late.

At least you know the cost involved but I agree that sedating a 3 year old seems like overkill but I have no knowledge of medicine.

[brewer12345]

I think you need a new dentist.  IV sedation of a 3 year old?  For fillings?!!!

[BigRed]

He certainly didn't sit still for the exam, so I can't imagine how cavities would be filled without sedation at this point.  But, I'm definitely thinking of calling around for a second opinion.  Which the insurance won't cover, I'm sure.

[savingtofreedom]

Can't they just numb around where they have to fill the cavities?  Also may be worth laying off the sugar from now on - this is coming from a 33 year old sugar fiend that still has high dental bills - I wish I had broken the addiction earlier in life.

I have had some crappy dentists so I would for sure look at other dentists covered by your insurance to see what they say. 

[bogart]

This isn't really about cost, indeed, it may not be a cost-saver, but intending no offense I'm pretty sure I'd want a second opinion before I'd consent to sedating a three-year old for dental work. 

Also, your post doesn't address this at all and it may be it's something you already have all the information you need about and are totally on top of, but if you're not 100% confident that's true, in your shoes, I'd want to be sure I had good information about and was doing a good job cleaning my child's teeth (indeed, appropriately managing dental hygiene is 100% something I always talk both my my own hygienist and with my 6-year old son's about; it seems like I'm always learning some way to do something better).  It's not that 2 cavities sound like the end of the world, but it does sound like it's probably toward the high end of what might reasonably be expected.  This too could be an argument for seeking out another dentist -- I've found real variation in how good dentists and the hygienists who work with them are about communicating effectively about this. 

[Frankies Girl]

For a brief period of time, I had no dental insurance. It's free at my company now thank goodness...
When I was paying everything out of pocket, I had no problem asking if there was a cash discount. There usually was. They also discounted at least 20% off if you had no insurance.

I just did a quick google and a toddler getting IV sedation is the last resort. Most of the sites recommended nitrous if the child wasn't scared of the mask. I'd ask if the dentist was a pediactric specialist, and maybe call around for a second opinion if this dentist is going for full on sedation right off the bat.

I had full on sedation for a medical procedure a few months ago that was a bit more involved than a few fillings and probably used up more meds with me being a full grown adult, and my anesthesiologist fee was $500, so I do wonder about the high cost you've been quoted. May be apples and oranges considering, but it NEVER hurts to check or get a second opinion. It's not being cheap; it's being smart and making sure you're not being taken advantage of.

[Irishmam]

DS 14 lost his brand new retainers (top and bottom) several weeks ago. The replacement price was $300 EACH. I called several local orthodontic offices and got varying prices. My own orthodontists office finally gave me a 50% deduction, but I had to threaten to leave their practice first. I would ask co-workers / friends / local / pediatrician's office for recommendations for a pediatric specialist dentist. Then call and explain your issue. They may give you a ball park price to work with and then you can go back to your own dentist to negotiate price.
Incidentally, same DS had an extraction at age 2, one dentist wanted to anesthetize him, but I wasn't comfortable with it and found someone else who handled him beautifully while I went outside to cry /puke cos they were hurting my baby. Call around, it's worth spending the time on this.

[BigRed]

We just talked to a dentist friend of ours, and she strongly recommended we get a second opinion, even though she often works with the pediatric dentist we got the diagnosis from.  Of course, insurance doesn't cover a second opinion, but it is the right thing to do.   

A pediatric dentist is someone whose job it is to make the kid comfortable, sedating them at the slightest sign of difficulty is not what you take a kid to a pediatric specialist for, right?

Thank everyone for the support in assuring me I am not a crazy person for questioning my dentist's recommendation.

[smalllife]

Why are you filling in cavities for baby teeth anyway?  He'll lose them in a couple of years regardless . . . . .

[BigRed]

He won't lose the back molars, where the cavities are, until he's 11. 

[chucklesmcgee]

He won't lose the back molars, where the cavities are, until he's 11.

Well Christ, at least teach the kid to brush his teeth. Maybe keep acidic foods away from him? No idea how a kid that young could have that much decay. But I am sorry.

Shopping around is nice, but just a small factor. You can get free flu shots from many drug stores or other events or pick up generic meds (which are THE 100% SAME as the name brand barring some special exceptions). But when it comes to care that you need it can be nearly impossible to compare costs. Try calling a hospital and ask how much it would cost to get an MRI under such and such insurance and you'll probably be laughed at, handed off to a half dozen agents and then told it depends.

You can try getting a general estimate here: http://www.newchoicehealth.com/. Haven't used it, but I think it's alright.

It's often very difficult to determine whether or not more expensive treatments are worthwhile. Ultimately your health is the only thing you have.

It's probably cheapest to focus on staying healthy, eating right and being active. The cheapest healthcare option is not to need it in the first place.

[twinge]

Well Christ, at least teach the kid to brush his teeth. Maybe keep acidic foods away from him? No idea how a kid that young could have that much decay.

Typically 3 year olds are not really able to brush their teeth properly--parents are still doing it at that age.  But if a 3 year old has significant molar decay it's usually because of a structural issue with the molar--like a rough surface that traps bacteria/plaque despite brushing (or a habit like going to sleep sucking a bottle).  Did your dentist talk to you about figuring out causes for the decay?  My vote is for a second opinion too. 

[secondcor521]

Also...sealants.

I grew up without them and did an OK job of brushing my teeth as a kid, and had cavities in probably five or six molars.

My three kids have had sealants from their pediatric dentist, and between the three of them have not had a single cavity.

Based on the above I highly recommend sealants and am thrilled that my kids have had them.

[BigRed]

We've avoided all the highest risk stuff - nightime bottles, juice, sippy cups and he doesn't like sweets, though he loves fruit.  We brush and floss his teeth, and so does he to build the habit.  But, sometimes these things happen, it seems.  We've obviously stepped up the intensity of our brushing lately and moved to introduce fluoride toothpaste and getting him to rinse sufficiently.  But, it does seem that his teeth may be more vulnerable.  The original dentist also recommended sealants (as I write this secondcor521 chimes in with the same).

I'm calling this afternoon to set up a second opinion.

It's probably cheapest to focus on staying healthy, eating right and being active. The cheapest healthcare option is not to need it in the first place.

Well sure.  But nothing is guaranteed in life, and the question was about how to best handle when that isn't sufficient.

[tooqk4u22]

We've avoided all the highest risk stuff - nightime bottles, juice, sippy cups and he doesn't like sweets, though he loves fruit.  We brush and floss his teeth, and so does he to build the habit.  But, sometimes these things happen, it seems.  We've obviously stepped up the intensity of our brushing lately and moved to introduce fluoride toothpaste and getting him to rinse sufficiently.  But, it does seem that his teeth may be more vulnerable.  The original dentist also recommended sealants (as I write this secondcor521 chimes in with the same).

I'm calling this afternoon to set up a second opinion.

It's probably cheapest to focus on staying healthy, eating right and being active. The cheapest healthcare option is not to need it in the first place.

Well sure.  But nothing is guaranteed in life, and the question was about how to best handle when that isn't sufficient.

A significant contributor to poor teeth is usually lack of flouride....some areas have flourinated water and some don't.  And if you water is not flourinated then your little one should be getting a flouride pill.

[BigRed]

Speaking of

A significant contributor to poor teeth is usually lack of flouride....some areas have flourinated water and some don't.  And if you water is not flourinated then your little one should be getting a flouride pill.

Sadly, voters in Portland, OR rejected Fluoridation: http://www.usatoday.com/story/news/nation/2013/05/22/portland-fluoride-water/2350329/

Fortunately, we live in LA which has fluoridated since the mid-90s.  But, good advice to anyone not living with fluoridated water.

[Frankies Girl]

He won't lose the back molars, where the cavities are, until he's 11.

Well Christ, at least teach the kid to brush his teeth. Maybe keep acidic foods away from him? No idea how a kid that young could have that much decay. But I am sorry.

They have to get the teeth filled to prevent more teeth from getting cavities - it's a domino effect with teeth since decay is caused by bacteria.

I strongly believe propensity to develop cavities (like so many illnesses) is also genetic. I hated brushing my teeth as a kid, and did a half-assed job and I never had a single cavity until I was in my mid 20s (and hey, it was a tiny one where a tooth overlapped - even the dentist said it was a weak spot that had developed over years). So I hope the OP doesn't feel guilty since it sounds like they're doing the things they need to be doing, and it's just bad luck.

[anotherAlias]

Well Christ, at least teach the kid to brush his teeth. Maybe keep acidic foods away from him? No idea how a kid that young could have that much decay. But I am sorry.

Actually alot of cavities at that young of an age can be an early warning sign of diabetes.  I have a coworker who recently had his daughter to the dentist and found a bunch of cavities (she's 5 or 6ish).  He was really upset because he doesn't let his kids have junk food or many sweets and is vigilant about getting them to brush.  A few months later, his daughter was diagnosed with Type 1 diabetes.  The doctor said the cavities were due to the build up of sugar in her system.

[twinge]

The original dentist also recommended sealants (as I write this secondcor521 chimes in with the same).

Yep, I had sealants as a kid and so do my kids--we have two genetic issues-- the quite common rough surfaced molars and a less common issue with the chemical composition of our saliva.  Before I got the sealants I had cavities as a kid, then I never got one again.  My kids don't have any cavities yet despite the dentist saying they were likely going to be very prone to them.

[bogart]

The original dentist also recommended sealants

I think these are the accepted approach nowadays and wish we'd had them when I was younger.  Our kid's dentist recommended them only for his permanent molars and I know one issue was that apparently the kid has to be able to be quite still and keep his mouth open a good long while -- ours got 3 (permanent, back) molars done at not-quite-6 and (I wasn't back there) apparently had to be a real trooper to allow them to be done (the dentist commented that he kept perfectly still with open mouth for 30 minutes even though he gagged -- reflex -- like 10 times).  So while I can totally see where they might be recommended for the OP's child's baby molars, getting them applied may be challenging for a kid that small (obviously not arguing with the dentist's recommendation here, just a heads-up). 

And, yeah, it does seem clear that some of us are more cavity-prone (because of tooth/mouth features) than others.  My dentist has told me that I have both a rough surface to my teeth and ample saliva and apparently neither of those things is good.  My childhood fillings (and now, several root canals/crowns to address the stress those put on the teeth) certainly attest to that. 

[BigRed]

Got the second opinion today.  The new dentist felt there was only one area of concern, that it wasn't a cavity yet, but an area of weakness in a deep crevice in the molar.  He recommended painting a fluoride varnish, which should not require any sedation and watching the area closely over the next year.