small change toward a rich life

Orthodontic sticker shock

No posts for the last couple of days — instead I’ve been spending a lot of time in orthodontist’s offices with the kids.

Up until this year, both girls had dental coverage through their mother’s insurance, but it was an HMO situation and the care was pretty poor. Fortunately, the job that Jak got earlier this year offered not just better dental coverage, but even $1500 for orthodontia, which none of us have ever had before. So I jumped at the chance to move the kids to a better class of tooth care.

Finding a good orthodontist presented the first challenge. I started with recommendations from my dentist’s office, and then cross-checked them against Consumers Checkbook’s ratings. I came up with two orthodontists in my area (actually three, but two worked out of the same office). So I made two sets of two back-to-back appointments, and we took both girls.

Michaela is 15, and at a casual glance appears to have wonderful teeth — more straight and even than mine have ever been. Closer examination reveals a perfect left side but a messy right: one of her top permanent teeth never bothered to join the party, while — almost as if by compensation — her bottom jaw sprouted an extra. Unusually enough, the spare tooth is sitting behind (on the tongue side) of her other teeth, pushing them outward … which means that whenever the subject of teeth comes up, Jak and I affectionately call her ‘Shark Girl’.

Claire, at 9, has some typical minor crowding in her lower front teeth, but far more worrisome to me was the way that her upper front teeth have come in tilted sharply inward. Turns out this has to do with her lower jaw being set too far back; it’s also giving her a convex profile with a ‘weak chin.’ (In ortho-speak, she’s Class II, division 2.) I won’t go into all the details except to say that we’ve decided to put her on a ‘wait and see’ plan, where she goes in every six months for the doctor to measure her growth rate and decide when to intervene, with a likely start sometime in the next two or three years.

For Michaela, the two doctors’ recommendations were surprisingly different. One doctor explained that since Michaela had not just one but two molars in behind the missing upper tooth, they wouldn’t be able to make enough room to pull the impacted tooth down, and so would just move the other teeth to cover the hole. The other doctor recommended first expanding the palate slightly (still possible at 15) and then moving the other teeth and pulling the impacted tooth down. She said that if we didn’t, the only way to get a balanced mouth would be to pull three perfectly good teeth from the other three corners.

Faced with these two very different approaches, I was more glad than ever that we’d gotten multiple evaluations. Most orthodontists offer the initial consultation for free; I strongly recommend going to two or even three different doctors if you can.

The doctors had one thing in common, though: they both charged more than either Jak or I had imagined. He was apparently hoping for around $3500 per, or $2K after insurance; I was expecting in the neighborhood of $5K, or $3500 to us.

The total quote for Michaela was $6000 by the ‘cover the hole’ orthodontist and $6500 by the ‘pull the tooth down’ one. Neither covers extraction of the extra bottom tooth, which will be done by our dentist; with the latter we’ll also pay a separate $235 for out-of-house x-rays, plus an unknown amount for a surgeon to attach a ‘button and chain’ to the upper tooth so it can be maneuvered down, so the total cost will be more like $7500 when all’s said and done.

Optional upgrades included a) clear brackets on the top, for $300 extra, and b) custom wires to reduce the time in braces by around 6 months (or about 1/4 of the total) for $950 extra. But I was wincing long before we ever got to those numbers.

Despite the extra expense, though, we’ve decided to go with the ‘pull the tooth into place’ option. My opinion is that getting this right will be important for a long time to come, and dentistry is not a good place to be frugal. We are, however, skipping the cosmetic and high-tech upgrades.

Both offices offer 2-year financing at 0% interest, or a 5% discount if you pay in full up front. Right now, with our highest available savings rate at 3.65% (and falling), I considered dipping into our emergency savings to pay the full amount. After insurance, we’re left with about $5K now and another $1K of outside costs at various points. (The kids’ mother may contribute, but until that actually happens I’m running numbers from a worst-case scenario.)

What complicates things is our pretax medical savings accounts. Unfortunately, though we had planned for some orthodontic expenses this year, we were expecting a much smaller number. My account is already dry, and we’ve got around $1600 left in Jak’s for the rest of 2008. My medical FSA renews in January, so (assuming I’m still with my current employer) if we went on the payment plan we’d be maybe $600 over for the year, and I could factor the rest into 2009.

Since Jak and I are both in the 25% tax bracket, though, we’re going to be better off taking the payment plan and running as much of the cost as possible through the FSA. That’s almost 33% (once you include FICA) of every dollar we don’t have to send the government, which makes a lot more difference than a percent or two of interest.

Since we’re expecting a similarly exorbitant outlay for Claire in a couple of years, we need every last break we can get.

(Photo by Pikaluk.)


4 responses

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  1. Richard says

    Depending on your FSA administrator and how the bill defines the expenses you may have trouble getting the FSA to reemburse you.

    Ours is really strict that an invoice needs to be shown to prove that every expense is covering services from the current year.

    If we had a surgery in december for $6000 with free follow up visits, they wouldn’t let use use the next years money. On the other hand, if we had free surgery with expensive follow ups the following year, they would pay for it. It would be the same amount of money and services, just the way it’s invoiced that would matter.

    We ran into this a little bit with my wife’s prenatal checkups which we paid for all at once (In March), but which happened over the new year period. Eventually we got a broken down invoice which let us get back money for the visits in January through March.

  2. karawynn says

    Thanks for the heads-up, Richard. I guess that’s one more reason to go for the two-year plan over the up-front payment.

    One nice thing about the FSAs we have now is that we get preloaded MasterCards that we can use right away, without waiting for reimbursement. Waaaaay more convenient.

  3. Fahmi says

    I assume the FSA is different from the HCSA (Health care savings account)? I ask, because my job issues preloaded MasterCards for the HCSA, but if a “charge” is over a certain amount ($75?) then you have to file follow-up paperwork with receipts. And I wondered if there was any similar paperwork associated with the FSA (if it’s different).

  4. karawynn says

    No, FSA and HCSA are the same thing — or rather, HCSA is one of two types of possible FSAs, the other being dependent care. But it’s the one in question here. (I’ve just never heard anyone refer to them as anything other than ‘FSA’.)

    I think it depends on the vendor? Mine says ‘keep receipts just in case’ and reserves the right to challenge any purchase, but so far hasn’t done so. I am certainly loving the lack of paperwork thus far …

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