Don't forget to floss!

A few days ago, Trent came down with a toothache. At first it was a mere twinge. "I'll wait," he thought, "and maybe it will go away." He popped a few Tylenol and kept it to himself. But the pain worsened, and when I noticed him wincing, he finally had to admit what was going on.

The dentist took an x-ray and announced that he would need a root canal plus a cap on one of his back teeth. Total estimated cost: $1800. "But I could buy a brand-new Apple laptop with that kind of money," Trent told her. "Isn't there another option?"

The other option was to simply pull the tooth, keep the wound clean, and live on liquids for two days while his gums heal up. Total cost: $108.

You can guess which option he chose. We don't even have $1800 in our emergency fund right now. Currently, he's downing nutrient shakes and water and dousing his mouth with saltwater at regular intervals.

I gripe whenever I have to pay $150 for a visit to the doctor, but in truth, the dentist is always more expensive. Always. They're forever finding another problem, another issue: a cavity, worn-down enamel, a chip, a little bleeding along the gumline. Every problem seems to warrant immediate attention, and every procedure comes complete with paralyzing sticker shock. Who can afford it? Whose emergency account can keep up with it? I don't understand why it has to cost so much when it's clear that the majority of the population can't afford such expensive treatments.

What's most frustrating is that we're pretty careful about our teeth. I brush twice daily, floss twice daily (yes, using the proper method), and rinse twice daily with enamel-restoring mouthwash. I don't drink soda or eat much candy. And yet the dental drama never ends!

Part I of II: If you don't have health insurance

To say that I have an intense interest in the current healthcare debate would be an understatement. My stake in this issue developed from my own not-so-good experiences with the U.S. healthcare system. When I discovered I was pregnant with my son, I didn't have health insurance. It was the first time in 27 years that I let my coverage lapse. My company didn't offer insurance to its employees, private insurers wouldn't touch me with a 10-foot pole after I checked the "pregnant" box on the application (because if you're applying for private insurance and are pregnant, pregnancy is essentially considered a pre-existing condition by many insurers), and we made too much money (read: lower middle class income) to qualify for state aid. We paid for my prenatal visits out of pocket ($5000). We also paid for an emergency c-section and a three-day hospital stay (more than $20,000). The bills poured in for months.

I now have a much better understanding of why medical expenses often go hand in hand with bankruptcy. I also understand how stressful and, frankly, horrifying it feels to not have coverage when you need it (keep in mind that in 2007, more than 15% of all Americans lacked health insurance coverage, according to the U.S. Census Bureau).

Therefore, given the timeliness of the issue and my passion for it, I'm writing a two-part post on what to if you have no insurance (Part I), and how to obtain and make the most of private health insurance (Part II). I won't address employer-sponsored health insurance, but some of these tips may apply to that situation, too. I also won't address prescriptions because that could be a post in and of itself. Please keep in mind that this is not professional advice, nor is it comprehensive. All I can offer are homegrown suggestions that have sprouted from my own experiences. Feel free to comment and provide your own perspectives and advice.

So - What do you do if you have no health insurance? 

People without health insurance generally fall into two categories: people who don't have it because they don't want it/don't think they need it, and people who don't have it because they can't get it (36% of people who applied for private insurance were denied because of pre-existing conditions, according to a recent national survey). These tips apply to both situations:

1. Have an emergency fund in place, just in case. If you're not yet saving for a rainy day and you don't have health insurance, start hoarding now - even if you can't set aside all that much at one time. It's amazing how fast your savings will accrue if you contribute consistently to that fund. If you have a health emergency, you'll be able to pay at least part of the bill right away. In turn, that may make your care provider more amenable to a reasonable payment plan.

2. Find a family doctor who isn't a member of the Insurance Company Puppet Club, and see this person every year for a preventative physical and a women's/men's exam. I think some people would disagree with this piece of advice - because physicals can cost a couple hundred dollars, and you can get them on the cheap at clinics (see below) - but think of it this way: it's beneficial to have a doctor who knows your health history and, over time, grows to care about you as an individual, not just as a paying client. That doctor could serve as an advocate for you if your health takes a turn for the worse.

Is it possible to find a doctor who isn't squeamish about caring for someone without insurance? I think so, but you may have to do some hunting. Ask friends for recommendations. Look at doctor reviews on the Internet. Call around and see which office seems most accommodating. There are a lot of doctors out there, and you'll find someone who's happy to work with you. When you do visit this doctor...

3. ...remember that the price of health care is not set in stone. Actually, it is set in stone for a lot of people with health insurance: the prices are often determined in agreements between the insurance companies and the care providers. But if you don't have health insurance, you can haggle - for a lower price, for a no-interest payment plan, or both. When I had my son, the hospital took a significant chunk off the bill because we paid most of it up front (with the help of a loan from my parents). I also negotiated the cost of my prenatal care. Recently, my dentist's office allowed me to set up a no-interest payment plan that I can manage - meaning I don't have to rack up any additional credit card debt in order to get my teeth fixed.

It can't hurt to ask about your options. Don't forget that health care is a business, and if you don't like the service you're receiving, you can go elsewhere. It might take time and energy, but making some calls to different providers and telling them what you want and can afford could save you some big bucks in the long run. No-one should make you feel they're just doing you a favor by deigning to see you.

4. For run-of-the-mill illnesses and health care needs, consider using a discount clinic with affordable "menu pricing." These clinics are cropping up all over the country: in grocery stores, in malls, and even in airports. We visited the Little Clinic at our local Kroger store when our son came down with a persistent cough. A visit to his pediatrician would have cost more than one hundred dollars, and the doctor couldn't see him the same day. A visit to the nurse practitioner at the Little Clinic cost $60, and we didn't even have to wait. Clinics like these also offer physicals and immunizations (including flu shots) at a decent price. 

5. Take preventative measures. We can't choose our genes and we can't always control our environment, but we can control what we eat, what we weigh, and how much exercise we get. Studies have shown that maintaining an ideal weight/body mass index, eating a proper diet, and exercising all lower the risk of heart disease, cancer, and other major illnesses. 

6. Research advocacy groups and health care programs in your state and county. If you get really sick and can't afford your bills, where will you turn? Based on my own experience, I'd say that depends on the state in which you live. For example, here in Tennessee, the CoverTN program helps individuals who can't get health insurance elsewhere. There's assistance available, but you might need to do some investigating to suss out all your options (consider starting with your state and local government websites). This is where having a good doctor who cares about you can come in handy - he or she can likely recommend programs for which you may be eligible. 

7. Don't put your finances before your health. Your health is more important than money! If you experience chest pain or if your child is running a 104 fever that won't come down, don't put off going to the emergency room because you're worried about the cost. You are worth more than your bank account. You are not a pair of shoes or a new coffee table; you are not expendable or optional. You and your family deserve to get the medical attention you need. Worry about the money later.

A second opinion saved me $1832

Last week, I wrote about how I received some bad news about my teeth on the same day we paid off our credit card debt. My dentist's fancy new x-ray equipment apparently detected four cavities absent from the more archaic x-rays taken in January. In addition to the fillings, he also decided I needed two crowns at more than $1K a pop, and that I should replace two of my old silver fillings with resin-based composite. The total cost of this treatment plan came out to a whopping $3535.00. No amount of Novocaine could dull the pain of that bill.

Not entirely sold on everything he'd proposed - especially the part that involved replacing the silver fillings - I decided to seek a second opinion. I made an appointment with another dentist in the same practice. Today, in a consultation for which she did not charge me, she spent 20 minutes peering into my mouth and reviewing my x-rays. Her determination: while I do need one crown, the other one is, at this point, unnecessary. Moreover, the old fillings are in good shape, and there's no need to fix something that isn't broken. She then helped me prioritize which remaining issues to address first and which ones we can tackle in a few months. Clearly, she will be the person I trust with my teeth from here on out.

New total treatment plan cost: $1703. It's still expensive and still financially painful, but it's $1832 less than the first proposed plan. 

I spoke with the office manager about the best way to pay for these procedures, since my insurance won't cover it. She suggested Care Credit, but although it sounds like a pretty above-board option, I have no intention of going back into credit card debt. When I explained this to her, she assured me the dentist will allow me to pay off the balance in a couple of installments. I think we'll be able to make that work.

I'm glad I didn't assume that the first guy was the All Knowing, Never-to-be-Questioned God of Dentistry. I'm glad I sought the advice of another expert. This is the first time I've asked for a second opinion, but it won't be the last. From here on out, I will take a more proactive approach to my health care. Doing so could be beneficial to my well-being and to my wallet.