u/Ok-Woodpecker6251

Hello everyone.

My child is 3.5 years old and has significant dental cavities. I believe part of the cause may have been prolonged milk bottle feeding, which we have since tried to limit.

Recently, she has been experiencing dental pain, and we discovered she has about three abscesses in her upper gums. She is currently on antibiotics.

We have consulted a few dentists, and they are recommending either IV sedation in-office or general anesthesia in a hospital setting because she is very young and not cooperative during exams (nitrous won't help her since she may not likely follow directions).

I understand that anesthesia is generally considered safe nowadays compared to the past, but I am still very worried given her age. In addition, the cost is a minor concern because the anesthesia portion is not covered by insurance and must be paid out of pocket (the anesthesia department quoted 60 min is around $1500-2000).

One dentist mentioned that she may need at least 10 teeth extracted. I am very concerned about how this will affect her eating, speech, and overall oral development afterward. I also wonder whether she will need spacers or any other dental appliances to maintain spacing and alignment.

She is already a very picky eater, and I worry that this experience may make feeding even more difficult for her.

I am also unsure if removing this many teeth at her age is common practice or truly necessary. Some family members suggest leaving the teeth alone and waiting for them to naturally fall out, but I am worried the abscess infection could spread if not treated properly.

Thank you sincerely.

https://preview.redd.it/0hh61whzq62h1.png?width=1600&format=png&auto=webp&s=1da7890c3090f60e22b55eda6212bc9f74b867d8

https://preview.redd.it/1zev4fh1r62h1.png?width=1080&format=png&auto=webp&s=d37a2bca76ecd7fd548d366dc0ebd3e4f5d70bbc

Hello everyone.

I have a Delta Dental DeltaCare USA HMO plan for my child. We recently went in for a dental consultation because my child (3.5 years old) has some dental issues.

The dentist recommended IV sedation in-office because my child is not cooperative, and they were not able to complete X-rays during this visit. The plan is to do IV sedation at the next visit. So once the child is asleep, they will take X-rays and then complete the necessary dental procedures during the same appointment.

At this time, the dentist was only able to provide an estimate for extraction of four teeth, which is about $265 with insurance. She said those teeth are likely non-restorable and must come out. However, any additional treatment (such as more extractions or crowns) will depend on the X-rays taken during sedation.

The anesthesia fee is separate. It is not covered by dental insurance and must be paid out-of-pocket directly to the anesthesia provider (PDAA), since they do not accept insurance.

My main question is regarding the insurance benefit. My child’s plan shows a $450 out-of-pocket maximum. My understanding was that no matter how much the dental work costs (for example, $800 or more), we would only be responsible for up to $450 if the services are covered.

I called a DeltaCare representative, and they confirmed that once the out-of-pocket maximum is reached, insurance would cover 100% of covered services. However, when I asked the dental office billing department about this, they told me it works differently from medical insurance. They said that even if costs go above $450, I may still be responsible for additional charges depending on the treatment, and insurance may only cover a portion.

I’m trying to understand which explanation is correct and how the $450 out-of-pocket maximum actually applies in this situation. Thank you.

Hello everyone.

As you can see in the title, I have a Delta Dental DeltaCare USA HMO plan for my child. We recently went in for a dental consultation because my child (3.5 years old) has some dental issues.

The dentist recommended IV sedation in-office because my child is not cooperative, and they were not able to complete X-rays during this visit. The plan is to do IV sedation at the next visit. So once the child is asleep, they will take X-rays and then complete the necessary dental procedures during the same appointment.

At this time, the dentist was only able to provide an estimate for extraction of four teeth, which is about $265 with insurance. She said those teeth are likely non-restorable and must come out. However, any additional treatment (such as more extractions or crowns) will depend on the X-rays taken during sedation.

The anesthesia fee is separate. It is not covered by dental insurance and must be paid out-of-pocket directly to the anesthesia provider (PDAA), since they do not accept insurance.

My main question is regarding the insurance benefit. My child’s plan shows a $450 out-of-pocket maximum. My understanding was that no matter how much the dental work costs (for example, $800 or more), we would only be responsible for up to $450 if the services are covered.

I called a DeltaCare representative, and they confirmed that once the out-of-pocket maximum is reached, insurance would cover 100% of covered services. However, when I asked the dental office billing department about this, they told me it works differently from medical insurance. They said that even if costs go above $450, I may still be responsible for additional charges depending on the treatment, and insurance may only cover a portion.

I’m trying to understand which explanation is correct and how the $450 out-of-pocket maximum actually applies in this situation. Thank you.

https://preview.redd.it/h5osopv8162h1.png?width=1470&format=png&auto=webp&s=b5c6f009c235adc43c80c75574260c1cbeade901