Last week we took our daughter, Rachel, to the dentist for her bi-annual cleaning. Originally, she was scheduled to go in last April, but Rachel had a conflict with a soccer game so her mom decided to cancel it. Rachel’s name was added to the cancellation list, and for the last five months, the dentist’s office has been calling whenever there has been a cancellation to try and get her in. Normally, we would try to get Rachel in as soon as possible, but each time they called to schedule the appointment they would give us a time during school hours, and Susan and I saw no reason to remove her from class just to have her teeth cleaned.
Well, after months and months of trying, we were finally able to get a time AFTER school. Now, being five months late for a teeth cleaning normally wouldn’t seem like a big deal, but if that were the case, then I probably wouldn’t be writing this blog. During Rachel’s most recent teeth cleaning, it was also discovered that some of her teeth were starting to exhibit tooth decay. If you’re the parent of a young teenager, and you’ve been to the dentist within the last several years, then you probably know what’s coming next: SEALANTS.
In and of itself, sealants wouldn’t be a problem, but it’s what the dentist told us next that provided the inspiration for this blog entry. You see, Rachel recently celebrated her 14th birthday – in August. According to the dentist’s office, because Rachel is now 14, our insurance company might NOT cover the cost of the sealants! As it turns out, some dental carriers will only cover sealants up to age 13, while others will cover them beyond 13; it just depends on the policy.
This was very distressing news. No one likes to hear “not covered by insurance” during a discussion about dental procedures. So, the dental office has put in a call to our insurance carrier and now we are in the position of waiting to find out if this will be an out-of-pocket expense or not. If Susan had realized that Rachel was going to age-out of her coverage for sealants, we may have decided she could miss a game or could have pulled her out of school early and saved ourselves some money.
I could be mad at the dental office for not telling us this information sooner, but with all of the different patients they see and all of the different insurance carriers they have to deal with, I can certainly cut them some slack. The truth is the majority of blame rests on us. After almost a year, we were finally able to get Rachel in to see the dentist, but alas, it may be too late to have her sealants covered by our insurance carrier. We can, however, be prepared to discuss the possibility of sealants for David, Ethan, or Jacob before they turn 14.
It’s important to be aware of deadlines and age restrictions in your health and dental care plan and to review your insurance provider’s schedule of benefits periodically. You can usually find a schedule of benefits on the insurance company’s website or on your company’s HR intranet. If you are still not certain of the age restrictions on covered benefits, call the insurance carrier directly and ask if there are certain ages to be familiar with regarding the coverage provided by your plan. Share this information with your health and dental care providers and work with them to make sure any procedures that may be necessary are considered before your children “age-out.” This is your best defense against receiving such surprises and ultimately could end up saving you a lot of frustration—and some money too.