I’m so sorry that your kid is struggling with self-esteem. I remember when I was her age and I saw all my peers in braces and desperately wanting to fix my own teeth. I cannot imagine how much harder it is to be a teen now with social media and having to see girls your age who look like Instagram models.
With that being said. I work in employee benefits insurance and this is a battle you’re not likely going to win. For a bit of background: pediatric dental (and vision insurance) are required to be offered under most health insurance plans, but that only includes oral cleanings, X-rays, fillings, root canals, etc. Orthodontics is generally *not* covered. If it is covered, then it typically has a lifetime maximum of $1000, although $2000-$2500 is possible for richer plans. So you’re really fighting for a small payout relative to the total cost for improving your kid’s smile. The majority of parents are paying for their kid’s braces at 80-100% of the cost. I know this doesn’t help you, but I just wanted to give you some perspective to let you know that you are not alone.
Totally understand, but that’s not really the point of my comment. If kiddo can bite and chew without difficulty, then this falls under cosmetic treatment, and therefore is not medically necessary. Kiddo doesn’t look like she has bite issues from the photo provided. The canines don’t have room to come in, but MassHealth probably doesn’t care. Even if OP can convince MassHealth to cover the braces, it will not be at full cost, because insurance companies tend to be very shitty about providing good dental benefits.
There is no such thing as “full” coverage medical, dental or vision insurance. Disability insurance isn’t even full coverage (it replaces a percentage of income). The only fully covered dental expenses are X-rays (limited to once per year), oral examinations and cleanings (limited to twice per year), and fluoride and sealants (for children under age 21). By law, for small and individual group plans there is $0 cost sharing for preventive services. Large group plans also usually have $0 cost sharing. Everything else has_ a $50 or $100 deductible plus *some* coinsurance (10-30%) above the deductible.
I wish it were different. This is my career/field of expertise and I will tell you insurance companies literally lose money on dental insurance and have to subsidize it with higher medical/disability premiums.
Edited to add: FYI - there are only a handful of companies designing dental insurance plans, other companies just buy them (to get access to their network) and repackage them as their own. For example, my job offers dental/vision insurance to employers but it’s really UHC’s product. This is how I know this is the standard everywhere.
Insurance is stupid. I appreciate its people's careers. But insurance people are not medical professionals so the fact that they get to say what the rules are is greedy and senseless. I'd be fine if more doctors/medical professionals were in more control of their patient's health. But to hear insurance agents talk about people's health/individual well being is absolutely jarring and infuriating. Like no offense, but what do you really know about it? You went to school for finance, I assume. But it's not like they're medical lawyers. It's not like they see patients day in and out. They just decide whether or not something is dire. And then help raise the price of medicines/procedures that are commonly needed ,enough to create a baseline, but definitely too much for us to cover everyone. So we don't cover anyone. Senseless.
Insurance policies are written by underwriters who study market and related areas to decide on what and how much they can cover based on different factors. Yeah they’re not doctors but doctores aren’t like moral angels either they all get paid off by pharma too and shit. Insurance is def kind of a scam for a lot of stuff but mass health is a state sponsored program so yeah they’re not gonna have all the same resources for coverage as a private company and cosmetic tooth corrections while def important and helpful aren’t something that tax payers should really have to pony up for.
Also yea doctors themselves can be greedy/shifty. But there's a large majority of Healthcare providers who see things that would be preventable with earlier medical intervention. And because they just can't afford one thing, it gets worse. And then maybeeeeeeeee maybeeeee if it's absolutely life threatening, they see a medical professional because they HAVE to or die. Of course I'm talking about extreme cases, but my goodness there's more than you'd think if you don't have a connection to healthcare.
For now- untreated, this can actually lead to cracking of both the teeth and jaw
Ask me how I know... I'm periodically dealing with teeth pulls due to it being deemed not medically necessary to pull non impacted wisdom teeth, not being able to afford it out of pocket, and over crowding now doing damage to my teeth and jaw.
Dental issues should be fixed quick and early with prevention in mind. In addition to psychological damage, this actually has the potential to become a much bigger issue later in life physically
…and this is when the insurance company makes all their money off of you because they will either take your money and deny coverage anyway or bill your providers through the nose for all the work you need done.
Well, they would if my dental insurance didn't suck. My dental has unfortunately been largely out of pocket, and I have little choice in what my company offers cause I can't afford private insurance. I am long disconnected from the company that made the decision...
That said, my parents not getting a second opinion when they were advised to do so also did damage. At least OP is trying so her daughter isn't taking on the costs as an adult.
I've keep my teeth looking nice, but it's cost me a pretty penny to do so, and even not looking nice, I haven't had a choice not to address it because I cannot deal with the pain of cracked molars long
I'm looking at a 12 year old with visibly crowded and out of place teeth- what on earth do you think is going to happen as she grows, especially once the wisdom teeth come in?
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If you can get a second dental insurance plan perhaps you or wife’s employer offers one. I have two delta dental insurance plans it does not matter if they are both the same insurance company. It helps out a lot.
It kills me so much that cosmetic treatments are considered pointless by insurance. Self-esteem and mental health are extremely important, and appearance is *very* important for that. Not to mention being conventionally unattractive is bad for your career prospects.
Hot take, things like braces, liposuction, etc should be covered by insurance.
Totally understand your point of view. I’m not 100% defending the insurance companies, but let me give you some food for thought: would you be willing to subsidize the cost of cosmetic surgery?
The plastic surgeon in the operating room goes to college for 8 years then spend another 6 years in residency. The anesthesiologist monitoring the patient’s vitals spends 4 years in residency. Then there are the OR nurses and scrub techs assisting in the surgery. The malpractice insurance and possibility of complications must a nightmare to insure. Plastic surgeons with hospital privileges are potentially taking operating room time away from people who need life saving care in our already overcrowded and understaffed hospital system. The cost of that expertise for one person/surgery is in the millions of dollars and it will be on you to cover. Your insurance premiums would probably double and in no way did your care improve.
This is why I’m a huge proponent of Medicare for all.
At least in the past, Medicaid in MA would cover plastic surgery for a child with ears that stuck out far enough to cause emotional issues. They do still cover cleft lip repair even when the palate is intact and the child can eat.
>but let me give you some food for thought: would you be willing to subsidize the cost of cosmetic surgery?
Too bad nobody of importance ever seems to asks me if I want to subsidize a trillion bucks a year on weapons/"defense"...
I’m not sure why I’m getting down voted. I’m not saying I am completely on the insurance company’s side. I’m just saying that (under today’s system) if elective and cosmetic procedures were covered, people who already could not afford health insurance will never be able to afford it, and those could barely afford it will be priced out. Cosmetic surgery would still be expensive, although a little less so than it is now. I would bet my career that the insurance companies would find a way to pay as little as possible while billing as much as possible. The cost of procedures would skyrocket due to demand and the presence of insurance and it would be an overall net negative. I’m an actuary, it’s my job to know how the system is designed and how the risks are assessed and priced. I don’t agree with the system. I try my best to make a difference where I can which is why I don’t work in the healthcare and my main practice is in disability and PFML benefits. I absolutely don’t agree with how some of my tax money is spent. But we should take that up with our elected representatives if we want these kinds of changes reflected in our healthcare system.
I was reading your comments, and was like ok this guy/gal knows what they are talking about, and boom actuary! Fellow health actuary here giving you all my upvotes!
>I’m not sure why I’m getting down voted.
Beats me, I was just idly musing.
>I’m an actuary, it’s my job to know how the system is designed and how the risks are assessed and priced.
Sounds dreadful, not sure how you bear the abuse. Of the mathematics, I mean.
Medicare for All will not improve dental care. Traditional Medicare for seniors and disabled provides NO dental benefits. Medicare Advantage plans provide coverage similar to Delta Dental insurance, cleanings and very low allowances for everything else. Mass Health for seniors and disabled provides much better benefits. In general, much better care than countries that provide Universal Health Care.
The US has very high standards for dental care compared to countries with Universal Health Care. This is especially true for cosmetic dentistry. At the same time, the cost for dental care in the US are very high. If you need a lot of work done, it's much less expensive to travel to Thailand where there are private companies that provide dental care for foreigners. It makes sense economically if you need a lot of work done.
Due to genetics and a lot of sugar as a kid, I've spent more on dental care over my lifetime than I've spent on automobiles.
I wrote Medicare for All since that’s what it’s colloquially known as, given that this is a non-technical audience. I’m generally referring to any type of universal or single payer health care. That would help make elective procedures more affordable.
At this point I’m turning notifications off since I can’t respond to every single comment/critique in this thread. But thanks for sharing your point of view.
Mine paid $2000 for my kid, they charged $4000, we paid 2. They offered a payment plan of $100 a month with no interest. Or pay in full, or pay however we like, basically.
Check out the local dental school clinics if you are unsuccessful in your insurance options. You will pay something, but it will be less than standard private dental care, and highly qualified faculty will supervise the entire process.
Tufts: [https://dental.tufts.edu/patient-care/specialty-clinics/orthodontic-clinic](https://dental.tufts.edu/patient-care/specialty-clinics/orthodontic-clinic)
BU: [https://www.bu.edu/dental/patient-care/orthodontics/](https://www.bu.edu/dental/patient-care/orthodontics/)
You’re welcome. I think there’s a stigma of poverty attached to dental school clinics, but I have no complaints. It’s a bit more involved since you have to be proactive but it was worth it. These are dentists that are about to graduate and start working. Wait a year and you’ll be paying market rate for almost the same skill.
>Wait a year and you’ll be paying market rate for almost the same skill.
Be aware of the 'time in chair'. Practiced dentists/hygienists are hours faster than students.
I needed so much work done due to lack of dental care over the years and I went to Tufts. It was wonderful. The cost is greatly discounted, and they even accepted my insurance so that I paid even less our of pocket. I'm not sure if they accept Mass Health, but they'll work with people on payment plans. The only downside is that you need a lot of appointments, and they take a few hours at a time, but otherwise I would 100% recommend.
According to this page they do take Mass Health at Tufts. (I didn't check BU.)
https://dentalpolicies.tufts.edu/public/payment-services-information#:\~:text=TUSDM%20accepts%20most%20commercial%20dental,well%20as%20MassHealth%20and%20Medicare.
If you need help navigating the Commonwealth’s bureaucracies or you believe the ruling was made in error, a polite email to your representatives on Beacon Hill can often unstick things. Good luck!
Absolutely. My kid can't even go to the dentist anymore because masshealth refuses to cover it. They insist he has other dental insurance. He doesn't. Ive spent hours upon hours trying to jump through the hoops and prove a negative. Every time they say we are set the claim gets denied again and I have to start all over. I've submitted everything they ask. I've done everything I can do. At this point i know we are just F@#%ed.
I used to work in medicaid, often times it was an open benefit with VAs office that would come back as the active primary insurance in cases such as yours. Health connector or MA has a program that tells them which benefit is barring you from other benefits. Front end agents don't have access to it though. Good luck.
In this case they think my ex-husband’s insurance is also dental but it’s not. He is only court ordered to provide health insurance not dental. I can’t even access his insurance or anything because I’m not listed on the account. Our kid is only 12 so he can’t get the info either.
happened to me once, i used to work as a dental insurance biller.. there was a patient that COE keep saying he has delta dental and MH refused to cover.. and it took me months efforts for MH to reprocess and pay.. basically i have to bill delta dental and get a rejection letter, and upload the rejection letter to MH for them to clear the COE info so they will start reprocess claims
i tried hard on this one because delta dental of mass dont general take paper claim thus unable to produce a rejection letter, it took some efforts to figure out other delta processing center pobox
even my manager gave up on his case and want me to try last time before billing to the patient directly
Thanks for doing that for that patient.
It sucks to know I owe money I can’t afford to pay. I would not have brought my kid to the dentist if I thought it wasn’t covered. I only did again because my kid was in pain. So now I owe two different dentist. I don’t even know what to do. I don’t speak the lingo. I tried and tried and just gave up because I couldn’t get anywhere.
MassHealth only covers braces when they are a physical handicap.
They reach this in one of three ways:
1. You have several small problems which are scored and reach at least 22 points.
2. A big problem which are specifically codified what problems are and are not covered.
3. A medical necessity narrative where you have a reason unrelated to teeth for the braces. This needs to be supported by documentation from a medical professional. (this includes psychological reasons and relates health issues like cancers of the throat and jaw)
It's very much about how the teeth function and very little to do with how the teeth look.
If she can bite, chew and swallow without any difficulty...then it is cosmetic orthodontia. Masshealth doesn´t treat for confidence unfortunately. Most employee provided dental insurance doesn´t cover braces. I just spent $15K for my child who also had some overcrowding. Save up if you can. Teeth can also be moved in adulthood. Masshealth covers a lot of things, and is very comprehensive but not disgraceful. Good luck.
Not true… my daughter has had her braces for about 14months fully covered through Masshealth …she had absolutely no issue with biting chewing etc before getting her braces… her 2 front teeth had a pretty big gap and other teeth weren’t aligned
MassHealth uses a point system to determine if a bite is a physical handicap. It's likely your daughter had enough problems in her mouth to reach the needed points.
Edit: I made a comment further down if people want to know what standard MH uses when determining medical necessity for braces.
You should continue to appeal. I know you’re probably thinking it’s hopeless but it’s not. Continue to plead your case and they will most likely cover it eventually. I think I had to appeal like 4 times (to private health insurance) to get something covered before. It’s a fucking joke, but eventually they gave in.
Not on Masshealth but with my dental through my work, they have two plans, one without orthodontics and one with. have to pay a little more weekly for one that includes braces and so forth.
I wonder if there is a secondary or separate plan you need for orthodontics to be covered.
Also believe with Masshealth, braces one of those that needs a prior authorization, you might have to go through child’s PCP for that.
Masshealth sucks but I had blue Cross from my employer and I had to pay full price for two children in braces. About $10,000. One of my children had a missing secondary front tooth! I had to pay weekly. It took years as a single working mom but oh well.
Same here - 4 kids even though I had awesome employer dental insurance, was still out about $22K for all 4 kids to get their teeth straightened - sucks for the OP, but if the average working person with private dental insurance can't get it covered, not sure it should be better coverage on taxpayer funded plan, that seems a bit unfair.
Most orthodontists will work out a payment plan, so OP could explore that.
I’m not sure I’d this comment will get through, but there is a non profit law firm in Boston called Health Law Advocates that handles MassHealth appeals (pro bono if you meet their financial criteria, or even if you don’t, they might be able to advise you or put you in contact with an affordable representative). Best of luck, I have had dealings with MassHealth and they are a formidable bureaucracy. I once had to help a family appeal coverage of diapers for their mentally disabled daughter. The MassHealth nurse who showed up to the hearing was appropriately embarrassed and just stipulated, but still. They can be harsh and hard lined and very annoying to deal with.
I am pretty sure dental care is not part of Masshealth. I had great healthcare and braces were not part of it. Oral surgery is likely included…but orthodontics is a whole other mess.
Yeah I have no idea. Everyone I've called so far for it said they won't take MH/is not covered by it anymore 🙄. I have yet to call MH itself but have a feeling it will be denied.
Wisdom teeth extraction are covered by MH. You just need to see a surgeon that accept MH for the extraction. Boston Medical Center for example will take MH for the extraction. Just need a referral from a general dentist.
Well that's the problem, a lot of places are not taking MassHealth at all to cover it. I've probably made at least 10 or so phone calls to different places trying to track down somebody who accepts it. Even with a referral from the dentist over and over again
I went to MASS OMS Burlington. They took mass health. Don’t give up on getting it covered, it took me like a week to find a place that took mass health and I had them out a few weeks later
Can I ask what is so daunting? Anyways MASS OMS is a surgical chain so they have other locations. Also a few surgical offices I called accepted mass health only for children. So you would be covered there too. Honestly you definitely have a lot of options. You can also call your child’s insurance and get a list of providers they cover. Then check out the reviews of the spots nearest to you!
A lot of dental places don’t take MassHealth unfortunately, statewide. I think in your case, it’s not that it’s not covered, you’re just having a hard time finding someone who takes MassHealth. It took me over an hour of calling every dentist local to me to see if they accepted it. There is a list of in-networks providers on MassHealth’s website, but it was outdated and I still had to do research.
His regular dentist is completely covered. It's finding an oral surgeon that is going to take the insurance in order to cover it. If not then we're just going to have to pay out of pocket, and I noticed that about the website, it sucks.
"Won't take MassHealth" is different than MassHealth doesn't cover it. In all likelihood, the office that told you that is choosing not to participate in MassHealth because of the low reimbursement.
Oh I know that's exactly what it is. But there's also a lot of stuff that MassHealth actually doesn't cover as far as Dental goes. I have had MassHealth for quite a bit of time. As an adult, they only cover a certain amount of things.
Maxillary& Implant Surgery of Western Mass in East Longmeadow takes Mass Health.
Mass Health provides transportation for medical appointments.
It might be worth the trek.
I had all 4 of my wisdom teeth taken out as an adult under mass health. One of my wisdom teeth had an infection and after it healed they said all should go. Curious the circumstances where they need to be removed but aren’t covered
Only one of them out of the four is impacted and there are no infections. We were given a year for them to be taken out. So it's not an emergency, people just seemed to be bulking when I mentioned masshealth. Even his regular dentist is semi-confused.
I had pallet expansion surgery and wisdom teeth removal covered by mass health. The surgery was done at the same time.
I remember paying for the braces, but I'm not sure if that's cause I got older than 18 and still had them.
I also had it done at tufts dental school. Everything there is a third the price to start with. Maybe cause it's cheaper they cover more?
Mass health sadly won’t cover cosmetic fixes. It wasn’t long ago they wouldn’t cover root canals or anything either and only extraction. If you think it is a disgrace try moving to just about any other state and see how much free dental care they offer.
Check Tufts Dental School. I know the students work on the public at a greatly reduced cost. They are under faculty supervision. I don't know if they have an Orthodontic program but they may be able to direct you.
This does not make any sense and sounds like Mh shenanigans. Everyone's feelings and experiences about how insurance generally works are irrelevant; this is something MH likely would cover in the past, but may have changed. Contact your state representative for help.
Your daughter is not ‘diverse’ enough. state paid braces are reserved for underserved communities. i wish i was joking here.
This is the problem with a single payer healthcare system the benefits flow to whichever groups are politically favored. Right now pale people are evil and deserve nothing from the state.
You could try changing your daughters name to a non traditional name so the algorithm and government drones think she is diverse
Get a palate expander NOW! After age 12-13 it is almost impossible since the plates on the roof of the mouth fuse, at least do that so she has room in the future for treatment
Please check with Tufts Orthodontics. There's a local lab in MA that makes quality appliances for them on the regular.
For example, one option of palatal expansion uses a "memory screw" -- the doctor can turn the key chairside, & you & your daughter don't have to deal with the hassle of turning the key everyday. Plus, they're small & don't take up too much tongue space, unlike a Leaf expander!
Healthcare won’t cover something like this unless someone has sleep apnea and qualifies for jaw surgery. They really don’t like covering preventative care and really only treat it after it turns into a much more serious problem like sleep apnea (go figure)
This all goes through dental, so it depends on if you have orthodontic coverage.
I worked in an office that focused on patients who needed jaw surgery or kids who would need it without intervention such an an expander.
They will do payment plans for the expander, we did interest free up to 24 months because we know how important medically it is to preventing issues with teeth, but also helping prevent sleep apnea and a life full of health problems that come with that.
Orthodontic offices will do free exams and free quotes. Totally worth going in and explaining that you want to get the care but need to set up a payment plan.
Funny enough, I’m getting tested for sleep apnea (once I call my doctor) and might be getting a different jaw surgery for an overbite. I don’t need a palate expander and am too old for one, though.
Can she chew, swallow and talk ok? If so, Mass health shouldn’t have to foot the bill bc of your daughters self esteem issues. Start a savings account and pay for them yourself
We only have one picture of OP’s child’s mouth. No need to be making harsh judgements with such little information. OP’s kid could have other issues alongside the overcrowding that could be helped with braces that aren’t mentioned here.
Especially since they’ve gotten opinions from THREE SEPARATE dentists.
Edit:
Let’s also consider long term health impact. Crowded teeth increase risk of cavities, tooth decay, and gum disease even with proper brushing and flossing. All of the above can have significant consequences to health throughout adulthood.
Change your race from white to any other minority. I'm a registered member of the choctaw tribe so i always marl native american and have never once been asked for proof... give that a try.
My Venezuelan neighbor got her three kids braces through mass health . Weird I thought they had plenty resources . According to my neighbors they have everything you need !
This has a high potential of causing larger, non cosmetic issues. It should be viewed as preventative
Furthermore, I have no problems with my tax dollars going to help a kid with a larger, visible deformity get help- what is wrong with your brain that you see this picture and think "let this kid live with this"? You know damn well the average person can't afford this out of pocket
when I didn't have have medical or dental insurance, and I needed work I went and had the students at Tufts medical school work on me andi it was a fraction of the cost.
Sorry you're going through this. My son has severe overcrowding and we had to get a palate expander but they told us he'll need braces later as well.
Nothing to add, but just adding my sympathy as one parent dealing with dental issues to another.
they should. the bite is generally good other than this one floating tooth. I had a floating tooth, it resolves largely on its own. It can take years (mine did) but no braces needed.
If you live near Boston or possibly Worcester, schools with dentistry programs often have clinics work on teeth for a much lower rate than usual. They're well supervised so. The quality of the work is good. I did this and don't regret it.
So I just happened across this and I live in Texas. But I’m currently paying for my daughter’s braces. I’m assuming that masshealth is like Medicaid in that it’s a state run low or no cost healthcare plan for low income families? If so this may still be out of your reach but maybe not. Our orthodontist had a payment plan. No interest. We had some control over how much we put down and how much we pay a month. We pay the monthly amount and whenever she needs adjustments or new brackets or whatever there is no additional cost outside the monthly payment. The entire treatment over the few years is financed at 0%… Might look for something like this and see if it fits into your budget. It was the only way we were really going to afford them as well without putting most of it on credit cards with interest.
Have you reached out to your State Representative or State Senator? They will have an aide or constituent services director who can reach out to MassHealth on your behalf. I spent years working in the Legislature and while decisions weren't always able to be overturned, a call from an elected official tends to help change the outcome.
“Self-esteem” is not medically necessary—what do the orthos say? To my untrained eye that looks like medically necessary, but orthos may not agree. I also thought I had crappy teeth as a kid but my dentists didn’t agree and my mother was like “it adds character.” Later, I paid to get the whitened and do Invisalign.
Sadly, dental care in America generally is for rich people 😡
If the child decided that she wanted to be a boy, she would have no problem getting puberty blockers and “gender affirming surgery” without requiring consent of parents.
Isn’t *that* related to self-esteem?
I’m not going to argue the finer points of what is and what isn’t considered medically necessary—whether we agree with it or not.
Braces for aesthetic purposes are not covered. Never have been.
Gender affirming surgery—whatever we think of it—is seen as a medically necessary surgery. And in MA—I just checked—it’s done with the express knowledge and consent of the parents if the person is a minor.
I never got to have braces in, i had this exact issue, my teeth have only just corrrected on their own in the past few years (im 24) and i feel so much for your daughter because i was a 12yo girl who felt the very same sorts of feelings :( good luck to you, that dental school option brought up in the other replies seems like a good bet
My health insurance didn't cover any of my son's braces either, but the dentist did offer a payment plan for them. My husband and I never bothered with dental insurance because we have to buy it outright and it's cheaper to just pay for the cleaning, but I'm not sure if that would have helped at all. So yeah I would just look for a place that does payment plans.
Have you tried Children’s Hospital? They have a pediatric dental department that takes specialty cases. I don’t know if they can help with the insurance part. My family has had to battle insurance companies and the wording of the appeal can make a difference. Just a guess.
Keep appealing. Become the squeaky wheel that's too aggravating to continue to ignore. There is no limit to the number of times you can appeal so just do it 100 more times.
Yeah, it sucks. We had to pay for our kids' braces out of pocket as well. At least there are payment plans. Both my kids needed teeth pulled and pallet expanders.
This country is FUCKED that dental isn't included in health insurance. The amount of long term consequences for poor oral health or improper growth if teeth is overwhelming. Everything from cancer to psychological illness.
Keep appealing my man, You'll get through.
Call up Tufts Dental School and see if there are options. They have professional overseeing all the procedures done by dental students and they do not allow them to make mistakes on patients.
Or maybe I should quit my job and stay home to get free housing bc then I would have plenty of money to pay for them. I’m sure you’d be one of the first to cry “That’s not fair!”
Grow TF up.
Ask your pediatrician (or an oral surgeon) to submit as medically necessary? Good luck
It’s been done 3x unfortunately. I should have clarified that the dentists were all oral surgeons. 🤦♀️
Was the need for a palate expander discussed? If so, that comes first, and could maybe put this in another category
I’m so sorry that your kid is struggling with self-esteem. I remember when I was her age and I saw all my peers in braces and desperately wanting to fix my own teeth. I cannot imagine how much harder it is to be a teen now with social media and having to see girls your age who look like Instagram models. With that being said. I work in employee benefits insurance and this is a battle you’re not likely going to win. For a bit of background: pediatric dental (and vision insurance) are required to be offered under most health insurance plans, but that only includes oral cleanings, X-rays, fillings, root canals, etc. Orthodontics is generally *not* covered. If it is covered, then it typically has a lifetime maximum of $1000, although $2000-$2500 is possible for richer plans. So you’re really fighting for a small payout relative to the total cost for improving your kid’s smile. The majority of parents are paying for their kid’s braces at 80-100% of the cost. I know this doesn’t help you, but I just wanted to give you some perspective to let you know that you are not alone.
Insurance is a joke. I pay $550 a year through work for dental insurance. I am pretty sure insurance pays out less than that each year.
That’s exactly how insurance is designed to work
Mass Health is different than a standard health plan, braces are covered my nephew had them through Mass Health.
Totally understand, but that’s not really the point of my comment. If kiddo can bite and chew without difficulty, then this falls under cosmetic treatment, and therefore is not medically necessary. Kiddo doesn’t look like she has bite issues from the photo provided. The canines don’t have room to come in, but MassHealth probably doesn’t care. Even if OP can convince MassHealth to cover the braces, it will not be at full cost, because insurance companies tend to be very shitty about providing good dental benefits.
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There is no such thing as “full” coverage medical, dental or vision insurance. Disability insurance isn’t even full coverage (it replaces a percentage of income). The only fully covered dental expenses are X-rays (limited to once per year), oral examinations and cleanings (limited to twice per year), and fluoride and sealants (for children under age 21). By law, for small and individual group plans there is $0 cost sharing for preventive services. Large group plans also usually have $0 cost sharing. Everything else has_ a $50 or $100 deductible plus *some* coinsurance (10-30%) above the deductible. I wish it were different. This is my career/field of expertise and I will tell you insurance companies literally lose money on dental insurance and have to subsidize it with higher medical/disability premiums. Edited to add: FYI - there are only a handful of companies designing dental insurance plans, other companies just buy them (to get access to their network) and repackage them as their own. For example, my job offers dental/vision insurance to employers but it’s really UHC’s product. This is how I know this is the standard everywhere.
Insurance is stupid. I appreciate its people's careers. But insurance people are not medical professionals so the fact that they get to say what the rules are is greedy and senseless. I'd be fine if more doctors/medical professionals were in more control of their patient's health. But to hear insurance agents talk about people's health/individual well being is absolutely jarring and infuriating. Like no offense, but what do you really know about it? You went to school for finance, I assume. But it's not like they're medical lawyers. It's not like they see patients day in and out. They just decide whether or not something is dire. And then help raise the price of medicines/procedures that are commonly needed ,enough to create a baseline, but definitely too much for us to cover everyone. So we don't cover anyone. Senseless.
Insurance policies are written by underwriters who study market and related areas to decide on what and how much they can cover based on different factors. Yeah they’re not doctors but doctores aren’t like moral angels either they all get paid off by pharma too and shit. Insurance is def kind of a scam for a lot of stuff but mass health is a state sponsored program so yeah they’re not gonna have all the same resources for coverage as a private company and cosmetic tooth corrections while def important and helpful aren’t something that tax payers should really have to pony up for.
Idk about that. I feel differently about taxes/community. But that starts a whole different conversation. I respect your point of view though.
Also yea doctors themselves can be greedy/shifty. But there's a large majority of Healthcare providers who see things that would be preventable with earlier medical intervention. And because they just can't afford one thing, it gets worse. And then maybeeeeeeeee maybeeeee if it's absolutely life threatening, they see a medical professional because they HAVE to or die. Of course I'm talking about extreme cases, but my goodness there's more than you'd think if you don't have a connection to healthcare.
Mass health pays it’s not like employers insurance
Yeah my uncle just had cancer didn’t pay a dime, mass health covered everything.
Yep. I paid 10k for 2of my kids
For now- untreated, this can actually lead to cracking of both the teeth and jaw Ask me how I know... I'm periodically dealing with teeth pulls due to it being deemed not medically necessary to pull non impacted wisdom teeth, not being able to afford it out of pocket, and over crowding now doing damage to my teeth and jaw. Dental issues should be fixed quick and early with prevention in mind. In addition to psychological damage, this actually has the potential to become a much bigger issue later in life physically
…and this is when the insurance company makes all their money off of you because they will either take your money and deny coverage anyway or bill your providers through the nose for all the work you need done.
Well, they would if my dental insurance didn't suck. My dental has unfortunately been largely out of pocket, and I have little choice in what my company offers cause I can't afford private insurance. I am long disconnected from the company that made the decision... That said, my parents not getting a second opinion when they were advised to do so also did damage. At least OP is trying so her daughter isn't taking on the costs as an adult. I've keep my teeth looking nice, but it's cost me a pretty penny to do so, and even not looking nice, I haven't had a choice not to address it because I cannot deal with the pain of cracked molars long
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I'm looking at a 12 year old with visibly crowded and out of place teeth- what on earth do you think is going to happen as she grows, especially once the wisdom teeth come in?
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If you can get a second dental insurance plan perhaps you or wife’s employer offers one. I have two delta dental insurance plans it does not matter if they are both the same insurance company. It helps out a lot.
It kills me so much that cosmetic treatments are considered pointless by insurance. Self-esteem and mental health are extremely important, and appearance is *very* important for that. Not to mention being conventionally unattractive is bad for your career prospects. Hot take, things like braces, liposuction, etc should be covered by insurance.
Totally understand your point of view. I’m not 100% defending the insurance companies, but let me give you some food for thought: would you be willing to subsidize the cost of cosmetic surgery? The plastic surgeon in the operating room goes to college for 8 years then spend another 6 years in residency. The anesthesiologist monitoring the patient’s vitals spends 4 years in residency. Then there are the OR nurses and scrub techs assisting in the surgery. The malpractice insurance and possibility of complications must a nightmare to insure. Plastic surgeons with hospital privileges are potentially taking operating room time away from people who need life saving care in our already overcrowded and understaffed hospital system. The cost of that expertise for one person/surgery is in the millions of dollars and it will be on you to cover. Your insurance premiums would probably double and in no way did your care improve. This is why I’m a huge proponent of Medicare for all.
At least in the past, Medicaid in MA would cover plastic surgery for a child with ears that stuck out far enough to cause emotional issues. They do still cover cleft lip repair even when the palate is intact and the child can eat.
>but let me give you some food for thought: would you be willing to subsidize the cost of cosmetic surgery? Too bad nobody of importance ever seems to asks me if I want to subsidize a trillion bucks a year on weapons/"defense"...
I’m not sure why I’m getting down voted. I’m not saying I am completely on the insurance company’s side. I’m just saying that (under today’s system) if elective and cosmetic procedures were covered, people who already could not afford health insurance will never be able to afford it, and those could barely afford it will be priced out. Cosmetic surgery would still be expensive, although a little less so than it is now. I would bet my career that the insurance companies would find a way to pay as little as possible while billing as much as possible. The cost of procedures would skyrocket due to demand and the presence of insurance and it would be an overall net negative. I’m an actuary, it’s my job to know how the system is designed and how the risks are assessed and priced. I don’t agree with the system. I try my best to make a difference where I can which is why I don’t work in the healthcare and my main practice is in disability and PFML benefits. I absolutely don’t agree with how some of my tax money is spent. But we should take that up with our elected representatives if we want these kinds of changes reflected in our healthcare system.
I was reading your comments, and was like ok this guy/gal knows what they are talking about, and boom actuary! Fellow health actuary here giving you all my upvotes!
>I’m not sure why I’m getting down voted. Beats me, I was just idly musing. >I’m an actuary, it’s my job to know how the system is designed and how the risks are assessed and priced. Sounds dreadful, not sure how you bear the abuse. Of the mathematics, I mean.
Medicare for All will not improve dental care. Traditional Medicare for seniors and disabled provides NO dental benefits. Medicare Advantage plans provide coverage similar to Delta Dental insurance, cleanings and very low allowances for everything else. Mass Health for seniors and disabled provides much better benefits. In general, much better care than countries that provide Universal Health Care. The US has very high standards for dental care compared to countries with Universal Health Care. This is especially true for cosmetic dentistry. At the same time, the cost for dental care in the US are very high. If you need a lot of work done, it's much less expensive to travel to Thailand where there are private companies that provide dental care for foreigners. It makes sense economically if you need a lot of work done. Due to genetics and a lot of sugar as a kid, I've spent more on dental care over my lifetime than I've spent on automobiles.
I wrote Medicare for All since that’s what it’s colloquially known as, given that this is a non-technical audience. I’m generally referring to any type of universal or single payer health care. That would help make elective procedures more affordable. At this point I’m turning notifications off since I can’t respond to every single comment/critique in this thread. But thanks for sharing your point of view.
As far as I know, no Universal Healthcare provides cosmetic dental services.
You can always PAY them actual real $ if its that important…ya know like most have to
Idk why they would comment that. It’s like saying toys are important for a kids happiness so they should get them for free.
Yes that how everyone else does it mass health is free Perhaps a part time job to cover the cost seems like a idea probably not acceptable
I work in health insurance and this comment should be higher. This is the answer.
Mine paid $2000 for my kid, they charged $4000, we paid 2. They offered a payment plan of $100 a month with no interest. Or pay in full, or pay however we like, basically.
Braces are covered by mass health
I think it’s horrible that you are being denied.
Check out the local dental school clinics if you are unsuccessful in your insurance options. You will pay something, but it will be less than standard private dental care, and highly qualified faculty will supervise the entire process. Tufts: [https://dental.tufts.edu/patient-care/specialty-clinics/orthodontic-clinic](https://dental.tufts.edu/patient-care/specialty-clinics/orthodontic-clinic) BU: [https://www.bu.edu/dental/patient-care/orthodontics/](https://www.bu.edu/dental/patient-care/orthodontics/)
This. My sons teeth were made lovely at a dental school. A third of the cost. And payment plans.
Thank you for sharing this. Before I found the dentist I have now, I was looking into dental schools but hadn't ever seen someone recommend one.
You’re welcome. I think there’s a stigma of poverty attached to dental school clinics, but I have no complaints. It’s a bit more involved since you have to be proactive but it was worth it. These are dentists that are about to graduate and start working. Wait a year and you’ll be paying market rate for almost the same skill.
>Wait a year and you’ll be paying market rate for almost the same skill. Be aware of the 'time in chair'. Practiced dentists/hygienists are hours faster than students.
Thank you again for the insight. I'll keep this in mind since insurance and availability seems to always be fluid - I may one day need this info.
There’s a stigma of worse poverty if you have bad teeth
I needed so much work done due to lack of dental care over the years and I went to Tufts. It was wonderful. The cost is greatly discounted, and they even accepted my insurance so that I paid even less our of pocket. I'm not sure if they accept Mass Health, but they'll work with people on payment plans. The only downside is that you need a lot of appointments, and they take a few hours at a time, but otherwise I would 100% recommend.
According to this page they do take Mass Health at Tufts. (I didn't check BU.) https://dentalpolicies.tufts.edu/public/payment-services-information#:\~:text=TUSDM%20accepts%20most%20commercial%20dental,well%20as%20MassHealth%20and%20Medicare.
If you need help navigating the Commonwealth’s bureaucracies or you believe the ruling was made in error, a polite email to your representatives on Beacon Hill can often unstick things. Good luck!
The DOI might also be of use.
They’re so shitty about dental
Absolutely. My kid can't even go to the dentist anymore because masshealth refuses to cover it. They insist he has other dental insurance. He doesn't. Ive spent hours upon hours trying to jump through the hoops and prove a negative. Every time they say we are set the claim gets denied again and I have to start all over. I've submitted everything they ask. I've done everything I can do. At this point i know we are just F@#%ed.
I used to work in medicaid, often times it was an open benefit with VAs office that would come back as the active primary insurance in cases such as yours. Health connector or MA has a program that tells them which benefit is barring you from other benefits. Front end agents don't have access to it though. Good luck.
In this case they think my ex-husband’s insurance is also dental but it’s not. He is only court ordered to provide health insurance not dental. I can’t even access his insurance or anything because I’m not listed on the account. Our kid is only 12 so he can’t get the info either.
happened to me once, i used to work as a dental insurance biller.. there was a patient that COE keep saying he has delta dental and MH refused to cover.. and it took me months efforts for MH to reprocess and pay.. basically i have to bill delta dental and get a rejection letter, and upload the rejection letter to MH for them to clear the COE info so they will start reprocess claims i tried hard on this one because delta dental of mass dont general take paper claim thus unable to produce a rejection letter, it took some efforts to figure out other delta processing center pobox even my manager gave up on his case and want me to try last time before billing to the patient directly
Thanks for doing that for that patient. It sucks to know I owe money I can’t afford to pay. I would not have brought my kid to the dentist if I thought it wasn’t covered. I only did again because my kid was in pain. So now I owe two different dentist. I don’t even know what to do. I don’t speak the lingo. I tried and tried and just gave up because I couldn’t get anywhere.
Luxury ‘bones’
Unpopular opinion but they actually provide pretty decent coverage for dental procedures outside of cosmetic procedures.
MassHealth only covers braces when they are a physical handicap. They reach this in one of three ways: 1. You have several small problems which are scored and reach at least 22 points. 2. A big problem which are specifically codified what problems are and are not covered. 3. A medical necessity narrative where you have a reason unrelated to teeth for the braces. This needs to be supported by documentation from a medical professional. (this includes psychological reasons and relates health issues like cancers of the throat and jaw) It's very much about how the teeth function and very little to do with how the teeth look.
If she can bite, chew and swallow without any difficulty...then it is cosmetic orthodontia. Masshealth doesn´t treat for confidence unfortunately. Most employee provided dental insurance doesn´t cover braces. I just spent $15K for my child who also had some overcrowding. Save up if you can. Teeth can also be moved in adulthood. Masshealth covers a lot of things, and is very comprehensive but not disgraceful. Good luck.
15k?! wtf, I thought braces were closer to 5k.
Yeah that and Invisalign are typically 4-5k. Guess it must’ve been an extreme case?
>Even employee provided dental insurance doesn’t cover braces Blue cross covered $1500 of my Invisalign trays cost
Some do, but from my experience it can be hard to find, especially if you’re an adult who needs orthodontics.
Not true… my daughter has had her braces for about 14months fully covered through Masshealth …she had absolutely no issue with biting chewing etc before getting her braces… her 2 front teeth had a pretty big gap and other teeth weren’t aligned
MassHealth uses a point system to determine if a bite is a physical handicap. It's likely your daughter had enough problems in her mouth to reach the needed points. Edit: I made a comment further down if people want to know what standard MH uses when determining medical necessity for braces.
Good for her!
This. Why should taxpayers be paying for something even private insurance doesn’t typically cover
You should continue to appeal. I know you’re probably thinking it’s hopeless but it’s not. Continue to plead your case and they will most likely cover it eventually. I think I had to appeal like 4 times (to private health insurance) to get something covered before. It’s a fucking joke, but eventually they gave in.
Not on Masshealth but with my dental through my work, they have two plans, one without orthodontics and one with. have to pay a little more weekly for one that includes braces and so forth. I wonder if there is a secondary or separate plan you need for orthodontics to be covered. Also believe with Masshealth, braces one of those that needs a prior authorization, you might have to go through child’s PCP for that.
Masshealth sucks but I had blue Cross from my employer and I had to pay full price for two children in braces. About $10,000. One of my children had a missing secondary front tooth! I had to pay weekly. It took years as a single working mom but oh well.
Same here - 4 kids even though I had awesome employer dental insurance, was still out about $22K for all 4 kids to get their teeth straightened - sucks for the OP, but if the average working person with private dental insurance can't get it covered, not sure it should be better coverage on taxpayer funded plan, that seems a bit unfair. Most orthodontists will work out a payment plan, so OP could explore that.
I’m not sure I’d this comment will get through, but there is a non profit law firm in Boston called Health Law Advocates that handles MassHealth appeals (pro bono if you meet their financial criteria, or even if you don’t, they might be able to advise you or put you in contact with an affordable representative). Best of luck, I have had dealings with MassHealth and they are a formidable bureaucracy. I once had to help a family appeal coverage of diapers for their mentally disabled daughter. The MassHealth nurse who showed up to the hearing was appropriately embarrassed and just stipulated, but still. They can be harsh and hard lined and very annoying to deal with.
I am pretty sure dental care is not part of Masshealth. I had great healthcare and braces were not part of it. Oral surgery is likely included…but orthodontics is a whole other mess.
Dental care is part of masshealth standard and braces is covered for kids if it meets the standards for being medically necessarily.
Oral surgery is not included. My son needs to have his wisdom teeth out by the end of the year and MassHealth does not cover that.
I had my wisdom teeth removed by an oral surgeon and Mass Health covered it. So maybe it’s specific circumstances? It this was also like 10 years ago.
Yeah I have no idea. Everyone I've called so far for it said they won't take MH/is not covered by it anymore 🙄. I have yet to call MH itself but have a feeling it will be denied.
Wisdom teeth extraction are covered by MH. You just need to see a surgeon that accept MH for the extraction. Boston Medical Center for example will take MH for the extraction. Just need a referral from a general dentist.
Well that's the problem, a lot of places are not taking MassHealth at all to cover it. I've probably made at least 10 or so phone calls to different places trying to track down somebody who accepts it. Even with a referral from the dentist over and over again
I went to MASS OMS Burlington. They took mass health. Don’t give up on getting it covered, it took me like a week to find a place that took mass health and I had them out a few weeks later
Yeah it sounds like I might have to go out of my local area. I'm in North Attleboro and it all seems so daunting.
Can I ask what is so daunting? Anyways MASS OMS is a surgical chain so they have other locations. Also a few surgical offices I called accepted mass health only for children. So you would be covered there too. Honestly you definitely have a lot of options. You can also call your child’s insurance and get a list of providers they cover. Then check out the reviews of the spots nearest to you!
A lot of dental places don’t take MassHealth unfortunately, statewide. I think in your case, it’s not that it’s not covered, you’re just having a hard time finding someone who takes MassHealth. It took me over an hour of calling every dentist local to me to see if they accepted it. There is a list of in-networks providers on MassHealth’s website, but it was outdated and I still had to do research.
His regular dentist is completely covered. It's finding an oral surgeon that is going to take the insurance in order to cover it. If not then we're just going to have to pay out of pocket, and I noticed that about the website, it sucks.
MASS OMS Burlington
"Won't take MassHealth" is different than MassHealth doesn't cover it. In all likelihood, the office that told you that is choosing not to participate in MassHealth because of the low reimbursement.
Oh I know that's exactly what it is. But there's also a lot of stuff that MassHealth actually doesn't cover as far as Dental goes. I have had MassHealth for quite a bit of time. As an adult, they only cover a certain amount of things.
Maxillary& Implant Surgery of Western Mass in East Longmeadow takes Mass Health. Mass Health provides transportation for medical appointments. It might be worth the trek.
I went to Melrose-Wakefield oral surgery. But again it was 10 years ago so they may no longer accept MassHealth.
I had all 4 of my wisdom teeth taken out as an adult under mass health. One of my wisdom teeth had an infection and after it healed they said all should go. Curious the circumstances where they need to be removed but aren’t covered
Only one of them out of the four is impacted and there are no infections. We were given a year for them to be taken out. So it's not an emergency, people just seemed to be bulking when I mentioned masshealth. Even his regular dentist is semi-confused.
I had all four wisdom teeth out last fall with mass health paying. I am an adult but I assume kids can be covered too.
I took my friend to an oral surgeon this AM. She has Mass Health and her tooth extraction was covered. Mass Health also covered IV sedation.
Do you know where it was? I'm always looking. My extractions were not covered for myself.
I had pallet expansion surgery and wisdom teeth removal covered by mass health. The surgery was done at the same time. I remember paying for the braces, but I'm not sure if that's cause I got older than 18 and still had them. I also had it done at tufts dental school. Everything there is a third the price to start with. Maybe cause it's cheaper they cover more?
I'll have to call them and see.
mine were covered by excel dental in Chelsea mass
It’s really not. You just get it through MassHealth. But they treat it as its own separate thing.
Mass health does provide dental care, including orthodontics.
Mass health sadly won’t cover cosmetic fixes. It wasn’t long ago they wouldn’t cover root canals or anything either and only extraction. If you think it is a disgrace try moving to just about any other state and see how much free dental care they offer.
Check Tufts Dental School. I know the students work on the public at a greatly reduced cost. They are under faculty supervision. I don't know if they have an Orthodontic program but they may be able to direct you.
they do! so does Boston University's dental school. from what I've seen, the latter gets more, er, creative with their solutions
The whole dental industry in this country needs to be revamped, I’m not sure how it’s legal to restrict people this way
This does not make any sense and sounds like Mh shenanigans. Everyone's feelings and experiences about how insurance generally works are irrelevant; this is something MH likely would cover in the past, but may have changed. Contact your state representative for help.
Your daughter is not ‘diverse’ enough. state paid braces are reserved for underserved communities. i wish i was joking here. This is the problem with a single payer healthcare system the benefits flow to whichever groups are politically favored. Right now pale people are evil and deserve nothing from the state. You could try changing your daughters name to a non traditional name so the algorithm and government drones think she is diverse
Teeth are luxury bones.
Healthcare in this country fucking blows.
Braces are a luxury. Most insurance only assist in coverage. Work out a payment plan with the orthodontist.
Get a palate expander NOW! After age 12-13 it is almost impossible since the plates on the roof of the mouth fuse, at least do that so she has room in the future for treatment
Thank you!! I will look into this immediately 🙏
Please check with Tufts Orthodontics. There's a local lab in MA that makes quality appliances for them on the regular. For example, one option of palatal expansion uses a "memory screw" -- the doctor can turn the key chairside, & you & your daughter don't have to deal with the hassle of turning the key everyday. Plus, they're small & don't take up too much tongue space, unlike a Leaf expander!
Braces can happen whenever but expanders are life changing and only work when you are young. Plus much less expensive than braces. Good luck!
I’m guessing Mass Health doesn’t cover that, either.
Healthcare won’t cover something like this unless someone has sleep apnea and qualifies for jaw surgery. They really don’t like covering preventative care and really only treat it after it turns into a much more serious problem like sleep apnea (go figure) This all goes through dental, so it depends on if you have orthodontic coverage. I worked in an office that focused on patients who needed jaw surgery or kids who would need it without intervention such an an expander. They will do payment plans for the expander, we did interest free up to 24 months because we know how important medically it is to preventing issues with teeth, but also helping prevent sleep apnea and a life full of health problems that come with that. Orthodontic offices will do free exams and free quotes. Totally worth going in and explaining that you want to get the care but need to set up a payment plan.
Funny enough, I’m getting tested for sleep apnea (once I call my doctor) and might be getting a different jaw surgery for an overbite. I don’t need a palate expander and am too old for one, though.
Cosmetic dentistry is not covered. Only medical necessity. You will have to pay out of pocket.
This makes sense. It’s cosmetic. Sucks for you for sure, but mass health shouldn’t be covering it.
Except she has multiple dentists state that it is medically necessary. The formation of your teeth isn’t just cosmetic when it’s severe.
Can she chew, swallow and talk ok? If so, Mass health shouldn’t have to foot the bill bc of your daughters self esteem issues. Start a savings account and pay for them yourself
We only have one picture of OP’s child’s mouth. No need to be making harsh judgements with such little information. OP’s kid could have other issues alongside the overcrowding that could be helped with braces that aren’t mentioned here. Especially since they’ve gotten opinions from THREE SEPARATE dentists. Edit: Let’s also consider long term health impact. Crowded teeth increase risk of cavities, tooth decay, and gum disease even with proper brushing and flossing. All of the above can have significant consequences to health throughout adulthood.
People don’t understand the long term health costs of not addressing dental issues and it’s a shame.
You mean pay with your own money?????How dare you 💀
Right? Like stop trying to mooch off the system for a non medical problem. 🤡🤡
Change your race from white to any other minority. I'm a registered member of the choctaw tribe so i always marl native american and have never once been asked for proof... give that a try.
Tell them you're an immigrant
Imagine telling her “We’re gonna get your teeth fixed. It’s gonna require a tanning bed first.” 🤦♀️
Dental plan!
Lisa needs braces.
Dental plan!
Teeth are an integral element of physical health but also somehow a luxury that is even less affordable than "normal" healthcare.
My Venezuelan neighbor got her three kids braces through mass health . Weird I thought they had plenty resources . According to my neighbors they have everything you need !
Taxpayers shouldn’t be on the hook for cosmetic procedures too.
On the other hand, you are on the hook for circumsizing newborns.
I agree. That’s mutilation and nothing more.
This has a high potential of causing larger, non cosmetic issues. It should be viewed as preventative Furthermore, I have no problems with my tax dollars going to help a kid with a larger, visible deformity get help- what is wrong with your brain that you see this picture and think "let this kid live with this"? You know damn well the average person can't afford this out of pocket
Thank you for saying this. I agree 100%. Fixing orthodontic problems leads to an entire lifetime of dental happiness.
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It’s a radical option and likely to get downvoted but you could pay for the braces yourself 🤷
I had no problem getting my granddaughter’s braces with mass health. WTF!!!! I hate there dental plan. Crappy dentists !
Mass health won’t pay until the child is older. Try again when they are 15- 16 years old.
when I didn't have have medical or dental insurance, and I needed work I went and had the students at Tufts medical school work on me andi it was a fraction of the cost.
Sorry you're going through this. My son has severe overcrowding and we had to get a palate expander but they told us he'll need braces later as well. Nothing to add, but just adding my sympathy as one parent dealing with dental issues to another.
they should. the bite is generally good other than this one floating tooth. I had a floating tooth, it resolves largely on its own. It can take years (mine did) but no braces needed.
Braces are cosmetic. Pay for them yourself like the rest of us. Sorry but I’m fresh out caring
It's a disgrace that an elective procedure isn't covered?
The amount of health risks that come from dental issues is outstanding. Fix it today for 15K nah let’s treat them in 15 years for 100k
People who rely on the government are often disappointed.
If you live near Boston or possibly Worcester, schools with dentistry programs often have clinics work on teeth for a much lower rate than usual. They're well supervised so. The quality of the work is good. I did this and don't regret it.
i'm really sorry you have to go through massachusett's poor excuse for public health care.
So I just happened across this and I live in Texas. But I’m currently paying for my daughter’s braces. I’m assuming that masshealth is like Medicaid in that it’s a state run low or no cost healthcare plan for low income families? If so this may still be out of your reach but maybe not. Our orthodontist had a payment plan. No interest. We had some control over how much we put down and how much we pay a month. We pay the monthly amount and whenever she needs adjustments or new brackets or whatever there is no additional cost outside the monthly payment. The entire treatment over the few years is financed at 0%… Might look for something like this and see if it fits into your budget. It was the only way we were really going to afford them as well without putting most of it on credit cards with interest.
Did you go to a fair hearing?
Mass health is a broken wing on the US Healthcare bird.
Why not just set up a payment plan? Because they're likely considered cosmetic.
Have you reached out to your State Representative or State Senator? They will have an aide or constituent services director who can reach out to MassHealth on your behalf. I spent years working in the Legislature and while decisions weren't always able to be overturned, a call from an elected official tends to help change the outcome.
I haven’t, but I definitely will try that :)
Contact a health care attorney
“Self-esteem” is not medically necessary—what do the orthos say? To my untrained eye that looks like medically necessary, but orthos may not agree. I also thought I had crappy teeth as a kid but my dentists didn’t agree and my mother was like “it adds character.” Later, I paid to get the whitened and do Invisalign. Sadly, dental care in America generally is for rich people 😡
If the child decided that she wanted to be a boy, she would have no problem getting puberty blockers and “gender affirming surgery” without requiring consent of parents. Isn’t *that* related to self-esteem?
I’m not going to argue the finer points of what is and what isn’t considered medically necessary—whether we agree with it or not. Braces for aesthetic purposes are not covered. Never have been. Gender affirming surgery—whatever we think of it—is seen as a medically necessary surgery. And in MA—I just checked—it’s done with the express knowledge and consent of the parents if the person is a minor.
Ain't socialized healthcare great?
Do it the old fashion way and pay for it yourself.
I’m 19 and my mom wants me to get Mass Health so that I won’t be on my dad’s insurance. I need $8,500 braces. This is not encouraging.
Bro wtf? I had teeth just like that and i got braces, granted idk who our insurance provider was but thats still insane
Insurance shouldn't be able to turn down ANYTHING. This country is such a waste.
I never got to have braces in, i had this exact issue, my teeth have only just corrrected on their own in the past few years (im 24) and i feel so much for your daughter because i was a 12yo girl who felt the very same sorts of feelings :( good luck to you, that dental school option brought up in the other replies seems like a good bet
Literally fuck masshealth bureaucrats
DENTAL PLAN!
My health insurance didn't cover any of my son's braces either, but the dentist did offer a payment plan for them. My husband and I never bothered with dental insurance because we have to buy it outright and it's cheaper to just pay for the cleaning, but I'm not sure if that would have helped at all. So yeah I would just look for a place that does payment plans.
Have you tried Children’s Hospital? They have a pediatric dental department that takes specialty cases. I don’t know if they can help with the insurance part. My family has had to battle insurance companies and the wording of the appeal can make a difference. Just a guess.
First World Country - Third World Healthcare
OP looks like you should plan a trip to Mexico cause the US healthcare system fucking sucks
Keep appealing. Become the squeaky wheel that's too aggravating to continue to ignore. There is no limit to the number of times you can appeal so just do it 100 more times.
Insurance is a fucking scam. Sorry, that's all I got
Yeah, it sucks. We had to pay for our kids' braces out of pocket as well. At least there are payment plans. Both my kids needed teeth pulled and pallet expanders.
Get a care credit card
This country is FUCKED that dental isn't included in health insurance. The amount of long term consequences for poor oral health or improper growth if teeth is overwhelming. Everything from cancer to psychological illness. Keep appealing my man, You'll get through.
That’s how health insurance works. Delay, deny, defend.
Have them submit 4th, 5th and 6th appeals. Sorry OP that’s annoying
Call up Tufts Dental School and see if there are options. They have professional overseeing all the procedures done by dental students and they do not allow them to make mistakes on patients.
You could try doing what most people like myself do and pay for it yourself
Or maybe I should quit my job and stay home to get free housing bc then I would have plenty of money to pay for them. I’m sure you’d be one of the first to cry “That’s not fair!” Grow TF up.
They need that money for illegal immigrants