School me on Dental Insurance.

Mr.Ritz

Its sad to say I have soft enamel and my teeth are pretty much prone to many problems so I decided to get a dental plan to try and avoid anymore high dental bills. I thought I understood the paper work and it seemed reasonable 100 dollars for a filling, free cleanings, good amount paid for xrays. I go into the dentist thinking my cleaning and everything would be taken care of get told I have a cavity and I im like, its all on my insurance company go ahead and take care of it. So after a cavity, a cleaning, xrays and cancer screening sigh. The bill was almost 400.00 dollars. I get to the desk and they wanted 280!!! They said this is just a guess but the insurance company might pay more but we wont know until we send out the claim. Week later I get another bill from the dentist :C. The insurance company only paid 105 dollars, not even half of the bill. So I am looking to switch but I already have one of the higher plans that blue cross offers. So I don't know who what type of plan someone prone to dental problems should get.

Jasconius

If you are getting dental insurance on your own then this is pretty much par for the course.

You didn't personally invent some super scheme to save yourself a grand or two by first getting insurance and then immediately going to the dentist. They know people want to do this and they write the policies to protect against it.


Usually coverage takes several months to kick in completely (like 6, sometimes even 12), and then you'll get better coverage

I doubt you will find ANY insurance as an individual who will help you at all any time in this calendar year.

If you work for a company with good insurance then it usually kicks in instantly. But it doesn't sound like that.


but, if it matters, I have MetLife premium dental insurance and it has saved me three thousand dollars over the past 18 months

Mr.Ritz

I have had insurance with them for almost a year now and I understand that it only covers cleanings and xrays for the first 6 months. Then it covers fillings and then after a year everything major. So my last visit the fillings and everything were covered but it only paid out like 45 dollars or some crap due to fee schedule. My goal is to switch to another company right now so in 6 months I will have some form of coverage.

Mr.Ritz

I mean, thats what I am pissed about I have almost paid for an entire year and they only cover 100 bucks of my bill.

Mr.Ritz

The dentist also seem to have charged me more because I had insurance last time I didn't get charged for a cancer screening.. I s till dont understand how a filling cost 220.00 dollars :C

Mr.Ritz

Ok, so metlife is 13 dollars vs the 25.00 dollars I pay now but if I switch I will have to wait another 6 months before I can use it.

Deebaser

it depends on the plan and the regulations in your state. It's really best to think of dental "insurance" as a discount card. Is your dentist in their network? If not, find one that is.

noir_blood

Check other dentists as well. Mine actually sits down with me and tells me my out of pocket cost, and has a guarantee that even if the insurance doesn't pay them all the money, they won't go after me for it.

Maybe I just got lucky with them?

Jasconius

With Metlife you can call Metlife directly and tell them what billing codes the dentist will use, and they will tell you exactly how much money they will pay you

Mr.Ritz

noir_blood wrote: »

Check other dentists as well. Mine actually sits down with me and tells me my out of pocket cost, and has a guarantee that even if the insurance doesn't pay them all the money, they won't go after me for it.

Maybe I just got lucky with them?

Wow and his or her dental work is pretty good? The place I was at the dental work is great but they don't really go over costs because they feel like you should get it no matter what attitude. When I asked them how much the insurance card was going to cover they just said they don't know and even sent me another bill after I had already paid them.

Reverend_Chaos

First, I would call your insurance co. and have them walk you through the claim. They can tell you why they paid what they paid.

Second, ask if your insurance does Pre-Determinations or Pre-Approvals and if so - always, ALWAYS do that. I work customer service in the Dental industry and I get this exact kind of call multiple times every day. Unfortunately it is your responsibility to know and understand your plan...which sucks. Get a Predet and keep your copy of it.

Mr.Ritz

Reverend_Chaos wrote: »

First, I would call your insurance co. and have them walk you through the claim. They can tell you why they paid what they paid.

Second, ask if your insurance does Pre-Determinations or Pre-Approvals and if so - always, ALWAYS do that. I work customer service in the Dental industry and I get this exact kind of call multiple times every day. Unfortunately it is your responsibility to know and understand your plan...which sucks. Get a Predet and keep your copy of it.

Is that where the dentist tells you how much and you just call them to kinda shop around?

Pure Din

Mr.Ritz wrote: »

The dentist also seem to have charged me more because I had insurance last time I didn't get charged for a cancer screening.. I s till dont understand how a filling cost 220.00 dollars :C

I had nearly a dozen fillings last year (*ashamed*) and some of the big ones cost that much but I was getting white fillings and going to a dentist who did a bunch of fancy no-pain stuff because I'm a giant wimp about going to the dentist.

Is the insurance you have right now Delta Dental? It sounds really similar to mine. They said they would pay 50% for a filling and 100% for a checkup but that is only if you go to one of the dentists they list on their website and then get the cheapest possible fillings. The actual amount they paid ended up being like $45 for a cavity and $80 for the checkup.

Mr.Ritz

Pure Din wrote: »

Mr.Ritz wrote: »

The dentist also seem to have charged me more because I had insurance last time I didn't get charged for a cancer screening.. I s till dont understand how a filling cost 220.00 dollars :C

I had nearly a dozen fillings last year (*ashamed*) and some of the big ones cost that much but I was getting white fillings and going to a dentist who did a bunch of fancy no-pain stuff because I'm a giant wimp about going to the dentist.

Is the insurance you have right now Delta Dental? It sounds really similar to mine. They said they would pay 50% for a filling and 100% for a checkup but that is only if you go to one of the dentists they list on their website and then get the cheapest possible fillings. The actual amount they paid ended up being like $45 for a cavity and $80 for the checkup.

Nah its Bluecross blue shield but yeah they only paid like 50 bucks for the filling lol but didn't even cover all the check up because that was 120. The biggest thing that pissed me off is they didn't cover all the check up or xrays

Reverend_Chaos

Mr.Ritz wrote: »

Is that where the dentist tells you how much and you just call them to kinda shop around?

No. The Dental offices estimate is just that, and estimate. Think if the Dental office as a mechanic for your mouth. The last thing you do is roll your car(mouth in this case) up in there and tell them to fix it without any idea of what you are going to pay for. The problem with the Dentist's estimate is that if they are wrong they just bill you the difference. You want your insurance to process the Doc's treatment plan. So when you go in to get your teeth cleaned and the Doc says "Oh, I noticed X,Y & Z needs to be done" your automatic response needs to be - "OK, let's do that at the next appointment." Then when you leave you talk to the office lady to set up that next appointment, you set that out 6 weeks and ask her to have the treatment plan submitted to your insurance for pre-approval. Your insurance should send you something in writing telling you what they will pay for. Read through this carefully, and if you don't understand it call your insurance company and have them walk you through it, that is what they are there for. If anything gets denied or otherwise not paid for, find out why. Is your insurance stating that it doesn't need to get done, or is it excluded on your plan. Things like "cancer screenings" can be a legitimate charge, or it might just be BS that your Doc charges to pad his pocket.

My advice on picking a dentist is this - pick a smaller Mom & Pop style office. Find an office with hours that will suit you, and with billing/charging options that work for you. Does your dentist want you to pay 100% up front and let the insurance reimburse you, or will they invoice you for what the insurance doesn't pay? This is important. Do your homework, ask for referrals from family or co-workers. Check their standing with the ADA and state insurance boards. Stay away from huge Dental corporations with 10-20+ dentists, especially if they are a national chain.