Worse Than a Toothache

Dear Reader,

Do you have dental insurance? Sorry, to be so direct, but this is an important issue. I have heard numerous complaints about the dire state of the U.S. healthcare system, but I feel that most of these complaints are about doctor’s visits and medical procedures, not dental appointments.

As a kid, going to the dentist made me nervous for many reasons. I loathed fingers and metal instruments prodding the back corners of my mouth. I despised how the saliva would pool as my mouth would be forced to accommodate foam trays with unnaturally tasting fluoride gels. I feared the dentist announcing that I had a cavity and exposing me as a careless tooth brusher. While all of those past fears are no more than present annoyances, one new concern I have about a visit to the dentist as an adult is the cost of an appointment.

I was fortunate enough to stay on my parents’ health insurance until the very last possible moment that I was still eligible. At that time, I was working part-time at multiple jobs, none of which had benefits. My health insurance has lapsed more than once. Even under the affordable care act, at the time, it would have costed me $400+ a month to get coverage, which is, well — not that affordable! Not having healthcare made me nervous. I was more cautious when crossing the street; I made sure to take vitamins and upped my tooth-brushing game.

Finally, I was able to get health insurance through my university. “Hallelujah!” I thought, but there was a great big caveat — dental coverage was not included. Instead of offering dental insurance, my university offers discounted dental services through third-party providers. So, while I used to be able to make a tooth cleaning appointment every six months without “paying,” now, every visit to the dentist is treated like a transaction.

I was able to find a specialist accepting new patients online and I made an appointment. When I arrived at the office, the door was locked. I knocked and then waited a few minutes outside in the cold as the receptionist, let’s call her Lisa, helped another patient. Finally, when Lisa let me in, she inquired about my insurance. I awkwardly explained to her my “discounted dental program” situation and then she asked me how much my service would cost? This question caught me off guard, but then she told me the figure that I was expecting — $60.

After visiting this office more than once, I see that Lisa (I’ve only ever come when Lisa was here) always asks the patient about the cost of the service in advance. Most people pay out-of-pocket here, so it is important that they understand the cost before the service is performed.

For the $60 that I begrudgingly handed over, I got a standard cleaning — no complaints here and the dentist was nice. However, $60 is a lot for me and others who cannot afford to pay for insurance. It seems to me that people who come to this location are more likely to come because they need treatment, not because they just want to get their teeth cleaned.

More than once, I have seen people leave the office dejected, considering whether to return for further treatment. For example, once in the small waiting room, I witnessed an all too common scene. The woman shifted uncomfortably as she quietly said, “I can’t pay that,” when Lisa told her the price of a tooth extraction that she needed. Lisa then gave the woman a discount and the same reply — this time a plea — “I can’t pay that,” was uttered. Without consenting to the tooth extraction, the woman was released from the waiting room out into the cold Boston air, forced to consider her next steps. Would she make the follow-up appointment? How much longer can she live with an injured tooth? Where can she get the money? What else can be done? It is so sad to see people unable to afford basic care. Imagine if you needed a root canal — a horrible proposition — and then, to add insult to literal injury, you had to pay $1,000 to save the tooth. Many people just can’t afford this.

Part of me is cynical and wonders whether the office door is locked in case someone attempts to run out without paying (the door is locked on both sides!). Lisa has a kind demeanor and is bilingual, putting the many native Spanish speakers here at ease, when they visit the office. However, a kind reception can only go so far. Greater dental coverage for more individuals is an important issue. If you need further convincing, please do visit your local discount dental offices.

I wish you all good oral health!



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