Call us medical
expats, if you will. Or, really, dental/orthodontic expats would be more accurate. We didn't bid on Managua knowing how inexpensive, yet good, the dental care would be, but it's definitely something we will keep in mind for future bidding.
We've known for a while that at least two of our three children would need braces at some point in time. Kelsey still has a wee bit of time, where as Caitlin was nearly over due by the time we moved here. She was close (but not quite ready) in California.
Then we moved to Virginia, Peter went to Iraq, all you-know-what broke loose, he came back and that was the end of that. I was lucky to get the kids to the dentist (which nearly required valium for me, as it turned out Nick liked the dentist even less than the lady who cut his hair), and I completely forgot about things like well check-ups and such. Thank goodness the kids have immune systems like rocks from all of that rolling in the dirt and such. The dentist we finally stuck with (Nick finally liked) noted that Cait was finally ready for braces some time during our second year in VA. This was all well and good, however, braces are notoriously expensive. When you are still recovering from a year of lost extra income and dealing with unexpected medical issues, braces aren't something you want to think about.
We did have dental insurance, but had not yet come close enough to being able to use the orthodontic portion (and, of course, now they've cut the waiting period in half), and FSBP only covers so much. Then we started to think about the possibility that we might have to wait, no matter what, as we knew we would be moving and that any work on Cait would take at least 2, if not 3, years...time we no longer had in Virginia.
We ended up finding a great local orthodontist in Falls Church. Cait went to see him twice for thorough exams and just as I was trying to calculate exactly how much we would have to lay out for braces, the doctor came to the conclusion that while it wasn't spectacularly ideal, it would be far better to wait until our arrival in Managua. We could have one doctor see Cait through the whole deal, and we had started to research the issue and noted that prices seemed to be a bit lower.
Now that we are here, I can say "a bit" doesn't cover it. Without even submitting our claims to our regular insurance company, our maximum yearly dental exam bill (2 times a year x 5 people) would be $300/year. Subtract out the insurance paid, and it will run us about $60/year out of pocket (which will be paid from our health FSA).
Given that we were so close to being to the end of the waiting period, we opted to start Cait with the orthodontia. We then asked the price and without batting an eye, the dentist said, "$1600. You pay $300 down and then $54/month for 24 months." I repeated the information back to her with a stunned look and she had the look of understanding. She knew we were used to the higher prices in the States, and like many, were surprised that something like this could be so affordable without insurance.
Then I started thinking about the dental insurance we had planned on keeping. I did the math and realized that we would pay more in premiums over one year, than we would for Cait's braces (paid over two). Additionally, our regular health insurance will cover the cost of the first $1000 of Cait's orthodontia. In the end, we will owe $600 out of pocket, all of which will likely be paid from our FSA.
It didn't take long for us to realize that given it was open season, we needed to make a few decisions. After taking another long, hard look at the numbers, we opted out of dental insurance for next year and likely won't think about it again until we go back to the States (and even then, we will have to really run the numbers). And the irony of something so basic (good dental and orthodontia) being so reasonably priced, is not lost on me. As much as we think of the U.S. as being so advanced, they have a lot to learn about reasonable pricing for medical care, as well as dental. Even a recent trip to the ER (an hour long visit) only ran $69 (which is less than our co-insurance payment in the U.S.).
After we received the quote, we set up a visit with the orthodontist. He did a tiny bit of preliminary work two weeks ago, and then today was the big day: the braces. I figured Cait didn't need me pacing in the waiting room, so I grabbed lunch across the street. Thirty minutes later I returned, and 5 minutes after that, she was completely ready to go. I knew it would be fast, but that was ridiculous.
During that last 5 minutes, I signed the paperwork, paid the cash down payment, and received the receipt that, when we returned home, I promptly filed online with our insurance. We will go back (for now) monthly, have the braces checked, and pay the $54 fee, providing there is nothing to be fixed (broken brackets, etc.). She's not entirely thrilled, but we are ecstatic, knowing that instead of stressing about paying (egad) I don't know how much for braces, that money will instead be put in other savings accounts. Her teeth will be nearly perfect, and our wallets still intact thanks to the low cost and being able to save $1600 plus a year on dental insurance. And we are also thinking that Kelsey should be ready soon, so might as well take that plunge, too, while we are here...