Monday, April 9, 2012

Getting Care When You Can't Afford Coverage: Part 1

Welcome to the first part of an on-going series exploring how to get care when you can't afford coverage. In the coming weeks Cheap and Cheerful will cover some of the options available to those who need health and dental services but don't have insurance and can't afford to pay the astronomical out-of-pocket costs for basic services. Despite recent legislation in the US that extends health insurance to many who would otherwise have no coverage, many adults remain without any kind of coverage for health benefits.

A great deal of the literature published online regarding these issues is incredibly condescending. A cursory search for advice regarding the best way for the uninsured to afford a dental cleaning turned up embarrassingly out of touch articles urging uninsured readers to "give up pay-parking or the daily latte habit for a month" in order to afford a teeth cleaning every six months. To someone working a full-time job, or two jobs or three jobs and struggling to live paycheck to paycheck, this kind of advice is insensitive at best, and outright offensive at worst. In line with our objectives of researching and reporting on ways readers can live better on a budget, this week Cheap and Cheerful will explore some possible alternatives to climbing into the dental hygienist's chair uninsured.

"Toothbrush" CC-BY Lars P.

1) Have Your Teeth Cleaned at a Dental College
Getting your teeth cleaned at a dental college seems to be something many people have heard of, but fewer people have done. Admittedly, like many other things, the ability to obtain cheap teeth cleaning services at a dental college varies greatly depending on your geographical location. In some major cities, there may be 3 or 4 technical colleges offering discounted services to the public in exchange for allowing their students to practice their trade on an actual patient, whereas other towns may be at least 100 miles from the nearest dental college. If you aren't able to find a dental college in your local Yellow Pages, try looking up local vocational or community colleges. Many technical colleges offer associate degree programs for dental hygienists, and so offer cheap teeth cleanings to those willing to let students give-it-a-go on their teeth. After finding a dental college, or a technical college offering qualifications in dental hygiene, do a little additional searching to see if they have a website dedicated to this aspect of their institution. It may not be immediately clear if the number listed in the Yellow Pages entry for the college itself is the best number to call to inquire about a possible community patient outreach program. If searching for the name of the college in conjunction with terms like "patient" "clinic" and "care" doesn't return any useful results try ringing the number in the listing. Even if that number doesn't connect directly to someone who deals with a patient care program, it may connect to someone able to put you through to the right department.

If they are unable or unwilling to connect you, don’t get discouraged. Call back later and tell them you’re interested in the dental hygiene program there, but that you would like some additional information. Then ask them if they can put you through to the department directly, or give you more information on how to contact the program officer. While many colleges have clinics offering services to the public, each school will be different, and not every technical college with a dental program will have a patient care clinic as well. However, asking is free, so it’s worth asking to find out to potentially save significantly on your teeth cleaning costs.

Ideally, at this point you’ve found and spoken with the right person to book your cheap and cheerful teeth cleaning. Outside of showing up on time, the only other thing you’ll likely need to do is to fill out a medical history form upon arrival. The experience of the actual cleaning can vary widely from here, and can depend heavily on the experience of the student cleaning your teeth. It may take a less experienced student a while longer to complete a cleaning than it would a student with more experience. Certain aspects do seem to be standardized though, such as the presence of a licensed dentist or dental assistant overseeing the student’s work. Fees for a cleaning from a dental college can be as low as $10 and seem to top out around $60 in most areas.

Some criticize dental college cleanings, worrying that a dental student may potentially fail to diagnose the early signs of a problem that could later require surgery. However, remember that a dentist oversees student cleanings and that all dental hygienists and dentists were students themselves before becoming licensed professionals. Most dental hygiene students are trained to recognize common problems such as cavities, plaque buildup, and gingivitis. However, if you are experiencing dental pain or have other reasons to believe you could have a problem requiring surgery, the best thing to do is to schedule a consultation with your dentist.

Pros: significantly lower costs for a full teeth cleaning, some facilities may also offer X-ray services, cleanings overseen by a licensed dentist or hygienist.

Cons: variability of appointment availability, appointment lengths may be longer than an average cleaning by a fully licensed hygienist.



2) Try haggling or working out a payment plan with your current dental provider
Negotiating with your dentist can be tricky. Dental services can be expensive, and even basic preventive appointments can be cost prohibitive for those who have real expenses but not a real living-wage. However, many dental practices are small businesses and all dentists and dental hygienists are skilled professionals and like everyone else, they deserve to be compensated for their time. While asking for an outright discount may affront your regular dentist, discussing payment options with your provider is perfectly acceptable. Ask if your dentist offers any services on a sliding fee scale. Offering to pay cash up-front on the day may also increase your negotiating power, saving you as much as 10 percent of the cost of services rendered.

Pros: allows you to continue to receive treatment from your regular dentist or dental hygienist

Cons: not every practice will be able or willing to negotiate payment methods and/or costs


3) Consider Purchasing Teeth Cleaning Services Through a Deal-of-the-Day website
While buying your dental services through a deal-of-the-day website can be riskier than a cleaning from a reputable dental college, carefully reading the fine print can ensure that the deal you are buying fully covers the service or services you need, without requiring you to buy additional services or procedures in order to use the voucher.

Locating a Daily-Deal for a dental cleaning can be difficult, if not impossible to find out right. Sometimes searching for "Teeth Cleaning" or "Dental Care" and the name of a Deal-of-the-Day service produces useful results. Our search for "Living Social Teeth Cleaning" yielded a voucher for General and Cosmetic Dentistry in Tampa, Florida inclusive of a full dental exam, teeth cleaning, set of x-rays and bleaching treatment for $99, and this voucher for either a $49 dental exam, teeth cleaning and full mouth x-ray or a $129 teeth whitening treatment or a $1,8000 surgical tooth implant and custom crown in Macomb County, Michigan.

If today is not your lucky day on both Groupon and Google, then the other option is to periodically check the various deal-of-the-day sites, and bide time until an offer becomes available in your area.

Be sure to read the fine print of any discounted deal carefully. Most vouchers for discount dental services have certain limitations some of which include: non-transferability, the requirement of all services included in the discounted deal to be used by one customer in a single visit, and prohibitions on combining the discount voucher with other offers or promotions. These discount vouchers are also often only valid for new patients who have never visited the practice offering the deal-of-the-day coupon before.
The most obvious advantage to buying dental services through a deal-of-the-day service is the knowledge you'll be receiving treatment from a licensed dental practice. However, the actual level of service between dental practices can vary, so consider looking up reviews or asking for opinions from friends and acquaintances if they've previously used the practice selling the promotional voucher before committing to buying the discount deal.

Pros: obtaining services through a professional dental practice, some additional services such as x-rays and teeth whitening treatments are often included

Cons: level of service from practice to practice can vary, certain limitations and conditions may apply and are not always the same from deal to deal.

Hopefully one of these three options provides you with an option to make the dental care you need more affordable. If the three alternatives discussed aren't right for you, there are other options out there. Check out this article from MONEY Magazine for other ways to save on your dental costs such as joining a discount club, and advice on getting more out of your Flexible Spending Account.

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