r/HealthInsurance • u/skinnyalgorithm • 3d ago
Dental/Vision Will insurance cover my infected wisdom tooth if I call ?
Hi, my wisdom tooth partially ruptured on Monday and I’ve been in extreme pain since. I went to my apt today and they said it has 2 infections and they could not extract it because it’s preventing my mouth to only be able to move partially open. My throat also hurts and I’m having trouble swallowing and half my face is swollen including my throat, it looks like I’ve been punched in the face. My dentist told me I will have to wait a week before they can take it out and “do at home stretches with popsicle sticks” to get my mouth open. I can’t even move my mouth open more than half way so idk how this is going to work. I’m already on antibiotics I got through urgent care because they told me over the phone I couldn’t go 24 hours. They also said the infection may spread in the next week causing my airways to be blocked and I may have to go to ER.
I have BCBS. With this anesthesia pill it’s looking like it will be $896 and my insurance only covers the 1 tooth and not the anesthesia so I’m paying $500. I paid that today but my question is did I get bamboozled? Should I call my insurance myself? My grandmother who works in a doctors office and has a lot of medical knowledge called me and said I could get the whole thing covered if it was deemed “medically necessary” since it’s infected but I would need a referral to an oral surgeon. I also don’t know how they expect me to go back to work like this for the next week, I can barely talk or open my mouth and I’m a lawyer. Please advise.
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u/saysee23 3d ago
It's normal for sedation not to be covered. The prices sound typical.
Keep up with the antibiotics & dentist.
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u/cheesusfeist 3d ago
Do not screw around with an infection in your head. Go to the ER. You need antibiotics.
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u/saysee23 3d ago
They are on antibiotics. No ER needed, don't add to the expenses for no reason.
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u/Novel_Primary4812 3d ago
This is not good advice. OP may be in a serious situation and may need hospitalization and possibly IV antibiotics. OP should monitor the swelling and I am sure the urgent care told him to head to the ER if it worsens. This is no longer about who is paying for what.
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u/saysee23 3d ago
I'm sorry, they went to the appointment today. They are on antibiotics currently. Of course if it gets worse, like the Dr said, go to ER. But if it's responding as expected there's no need to rush to the ER just because y'all read this now.
It's a stressful situation for OP and people screaming go to ER now, not reading or taking into consideration they are currently under Dr's care....
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u/Kainlow 3d ago
Go to hospital. They have oral surgeons on site. You will need IV antibiotics.
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u/Holiday_Cabinet_ 3d ago
Only some do. My issue isn't as severe as OP's but I'm also dealing with a wisdom tooth infection from an impacted tooth, called all the ERs in my area none of them do. Waste of time and money to not call beforehand to be sure.
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u/skinnyalgorithm 3d ago
Thanks for sharing, this is what I’m afraid of. I now have 2 antibiotic prescriptions from 2 different providers.
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u/Holiday_Cabinet_ 3d ago
Hospital is still not a bad idea if it's as severe as yours it's just that they might only be able to give IV antibiotics and not be able to remove the tooth itself, so you'd still need to find somebody who can do that
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u/Kainlow 3d ago
Make sure you call a real hospital/ER. Not urgent care.
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u/Holiday_Cabinet_ 3d ago
I did. I even called one that an oral surgeon unrelated to the hospital claimed had oral surgeons on staff. The ER said no they did not.
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u/skinnyalgorithm 3d ago
Yeah they mentioned I might need that if it gets unbearable but I really don’t feel like sitting there for 7 hours just for antibiotics. They did prescribe me extra strength antibiotics I still need to go pick up but my car just broke down so it’s been a day. You think they will cover tooth removal with IV sedation at hospital?
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u/Kainlow 3d ago
I am a dentist btw. If you have swelling to the point that you can’t open your jaw you have a severe, recurrent infection. If it travels down into the spaces in your neck you will be in severe trouble and it will cost you more. Look up Ludwig’s angina. Do not fuck around with this, get it treated before it gets more severe. You can always earn the money back and pay over time.
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u/skinnyalgorithm 3d ago
Yeah I’m with you, I’m concerned they didn’t treat it same day or refer me to an oral surgeon. He said once the tooth comes out it should go away and the antibiotics will buy me 2 weeks at most. I have the apt set for next Friday which is the earliest they said they could do it because they want me to “stretch my mouth for a week with popsicle sticks”. Is this normal in your opinion for something like this?? I feel like delaying it is bad.
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u/Kainlow 3d ago
Do you have a fever? Is the swelling going down? That’s what you need to look for. If it’s not improving after starting ABX you need to go to OS. If I were you I would look up oral surgeons tonight and call them first thing in the AM to get in. A lot of them bill medical, ask over the phone. Find one, take an Uber, get it done.
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u/Regular_Focus 3d ago
This seems like the best advice, OP.
I hope you get some relief soon. I feel for you. I recently had an infection from an old root canal and I was in so much pain. I showed up at my dentist’s office at 6am and begged them to help me. Thankfully, they did. It ended up costing me $350 (that was with dental insurance) but I honestly would’ve paid 10X that for relief from the pain I was in…and I’ve even birth. In short, don’t worry about the money now, get this taken care of with an OS ASAP. I promise you that you will find a way to pay off whatever it costs later.
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u/ruthlesslyrobin 3d ago
Get estimate from dentist with insurance codes. Call the insurance and ask what they pay and what you are estimated to pay. See if the numbers are close. If not then ask why. Or find another dentist.
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u/corgi0603 3d ago
You need to be careful with this because infections can become dangerous, but we can't tell you how your insurance will cover this. You need to contact them, tell them about your situation, and ask what your coverage is for dealing with it. Ask what your coverage is for dealing with through your dentist, an oral surgeon, or the ER if it becomes absolutely necessary.
One note - most insurance companies have a fairly high ER copay that can run anywhere from $200-500+. And that's without deductible or additional copays for the actual services performed. If you're worried about cost, you need to deal with this through your dentist or an oral surgeon.