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Old 01-16-2016, 09:33 AM   #21
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The other thing to look at - some dentists offer a discount for cash payment... That's the real benefit of insurance - getting that negotiated rate.
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That's my sense too.
I have tried the cash discount request without success. Aetnaa Vital Savings, for about $100 per year, was supposed to give me access to those prices, but it didn't work; not all Aetna dentists participate, and even if they were on the list, they said "no" when I called.

This year my ppaca plan includes preventive dental and I get the rates...something I didn't even know I was getting!
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Old 01-17-2016, 07:06 AM   #22
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From a dentist's perspective: a few decades ago the practice model changed from charging your fee, accepting what insurance paid, and billing the patient for the balance, to agreeing to "participate" (PPO) in the plan and accepting the insurance fee as full payment, regardless of what that fee may be.
Dentists who felt their practices weren't growing as fast as they'd like agreed to participate. Over the years more and more dentists bought in, and now the dentist who is not a participant in some plan or another is a rarity.
As the big INSCOs' (MetLife, Travelers, Delta, United Healthcare come to mind) networks grow, and dental schools keep pumping out more and more desperate young grads with 300K-500K in school loans, they have been able to actually reduce re-imbursements to the providers.
Some plans are so bad, from the dentist's perspective that only the most desperate will accept them. You may draw your own conclusions as to how such desperation, and willingness to accept a re-imbursement that the majority of the profession would not agree to, may effect final outcomes.
More and more plans are approaching that threshold. To the INSCO's benefit however, the dental schools are supplying more and more desperate dentists every year, so the tendency is for these plans to be serviced by younger, desperate, less experienced dentists, with huge loans to pay off. Most often these are large facilities where the emphasis is on volume, rather than successful outcomes.
If you are covered under a plan where the dentist has agreed to accept a negotiated rate, be advised that it is highly likely that the owners of the facility know exactly what procedures are most profitable, least profitable, or simply not profitable at all, and to some extent (maybe a lot, maybe not so much) your treatment is being steered by the fee schedule, as opposed to what may or may not be your best dental options based upon your oral condition.
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Old 01-17-2016, 03:22 PM   #23
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Seems like the fee schedule drives dentists irrespective of being in a big practice or what pricing schedule is being used. I suppose if the pricing schedule is out of whack (procedure A nets $100/hr and procedure B nets $50/hr) that would create some incentive to lean toward A. Without any insurance company pressure, when a dentist sets his own rates, are they really the same $ per hour? I'd think that the basics would be loss leaders so that if you need a bigger procedure, you'd go to "your dentist" to get it done and that's where the high margins would be achieved. But yeah, the plans put the squeeze on prices, and I imagine if I had enough business, I'd reject the least generous ones. As a patient, I don't want the cheapest rates, I just don't want to pay double what the guy with insurance does, which is what I've run into. Luckily this year, I've got negotiated prices.
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Old 01-17-2016, 03:32 PM   #24
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My experience has been the same as others.... dental insurance is not worth the cost considering premiums, benefits, deductibles, waiting periods, etc. The premiums I have looked at are ~$1,000/year and benefits are limited to $1,000/year so I don't see much to like.
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Old 01-17-2016, 03:53 PM   #25
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If you have access to a dental school or a dental hygiene school and you have the time and patience, that is the way to go. At the school that I work at a full mouth set of x-rays that would cost about $150 in private practice is $30. $15 if you are over 55. Similar discounts for cleanings.
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Old 01-17-2016, 04:32 PM   #26
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Seems like the fee schedule drives dentists irrespective of being in a big practice or what pricing schedule is being used. I suppose if the pricing schedule is out of whack (procedure A nets $100/hr and procedure B nets $50/hr) that would create some incentive to lean toward A. Without any insurance company pressure, when a dentist sets his own rates, are they really the same $ per hour? I'd think that the basics would be loss leaders so that if you need a bigger procedure, you'd go to "your dentist" to get it done and that's where the high margins would be achieved. But yeah, the plans put the squeeze on prices, and I imagine if I had enough business, I'd reject the least generous ones. As a patient, I don't want the cheapest rates, I just don't want to pay double what the guy with insurance does, which is what I've run into. Luckily this year, I've got negotiated prices.
More sophisticated procedures, with lab bills, and a higher chance of running into complications USED TO command a higher hourly rate. Sometimes, in ideal circumstances, with good skills, those procedures would go very smoothly, and the dentist would make a good buck. But sometimes they wouldn't and the dentist would not do so great. The insurance fees are pretty much based upon the ideal scenario, but as soon as things go sideways, you can lose money. After a few of those misadventures, the wily doc learns to just avoid that can of worms, which is really what the INSCO want, to begin with. "I think we can just patch this",, and you can...for a while.
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Old 01-18-2016, 11:09 AM   #27
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I was talking about dental care with a retired lawyer recently... she is using our nearby dental school and is happy with the care she is receiving.

Kaiser has a dental insurance offering in their Medicare Advantage programs but you must sign up for it at initial participation to prevent adverse selection.
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Old 01-18-2016, 11:28 AM   #28
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I have tried the cash discount request without success. Aetnaa Vital Savings, for about $100 per year, was supposed to give me access to those prices, but it didn't work; not all Aetna dentists participate, and even if they were on the list, they said "no" when I called.
...
I tried asking our dentist for 10 years about a discount for cash, he didn't budge. So we went with a closer dentist and save $150-$200 total each visit.

OP might want to phone around and find another dentist as there are good ones that are cheaper.
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Old 01-19-2016, 11:37 AM   #29
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Two thoughts for the OP:

If your mother is Medicare-eligible, in some states Medicare Advantage plans include a basic dental benefit as a part of the MA premium (about a $500 limit), and then they are willing to sell you additional dental - but as others have said, these aren't great plans (they just don't make them).

If your mother can travel, and has a passport, travel to Mexico for dental care - especially in the border towns, or resort towns. Most of the dentists are educated in the U.S., speak excellent English. This is a cash-only type of service. Cost is significantly lower there. I had a friend who did just that while travelling with friends - she had major restorative work done, and was very satisfied.

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Old 01-19-2016, 05:33 PM   #30
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I was a dental hygienist before retirement. I worked in one of the top dental practices in the country. I have seen many dental plans and I will say that I have never seen a privately purchased plan that was more economical than just taking the money you would pay in your premium and just making a dental fund with it. A really good plan will cost a lot and then it will only pay a portion of any major work - lots of times only 50%. Then they will have a maximum per year that usually is not enough to anything of significance. It's a bad deal. Most dentists will probably let you do some sort of payment plan if you need lots of work. That is by far the best way to go.


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Old 01-19-2016, 05:42 PM   #31
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I was a dental hygienist before retirement. I worked in one of the top dental practices in the country. I have seen many dental plans and I will say that I have never seen a privately purchased plan that was more economical than just taking the money you would pay in your premium and just making a dental fund with it. A really good plan will cost a lot and then it will only pay a portion of any major work - lots of times only 50%. Then they will have a maximum per year that usually is not enough to anything of significance. It's a bad deal. Most dentists will probably let you do some sort of payment plan if you need lots of work. That is by far the best way to go.


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Old 01-21-2016, 11:44 PM   #32
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If you have access to a dental school or a dental hygiene school and you have the time and patience, that is the way to go. At the school that I work at a full mouth set of x-rays that would cost about $150 in private practice is $30. $15 if you are over 55. Similar discounts for cleanings.


This is the best solution. There are more visits because they are students but the supervisors are usually top-notch dentists who are closely supervising the work.


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Old 01-22-2016, 06:53 AM   #33
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^^ Agree. SWMBO and I had cleanings at our local community college dental hygiene program last year. They were very thorough and the price was right. We will be back again.
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Old 01-22-2016, 07:21 AM   #34
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I have never seen a privately purchased plan that was more economical than just taking the money you would pay in your premium and just making a dental fund with it. A really good plan will cost a lot and then it will only pay a portion of any major work - lots of times only 50%. Then they will have a maximum per year that usually is not enough to anything of significance. It's a bad deal. Most dentists will probably let you do some sort of payment plan if you need lots of work. That is by far the best way to go.
But won't most dentists charge you a much higher rate than the one negotiated by the insurance company?

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That's the real benefit of insurance - getting that negotiated rate.
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Old 01-22-2016, 01:52 PM   #35
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But won't most dentists charge you a much higher rate than the one negotiated by the insurance company?

Not a reputable dentist....

My previous dentist was a good dentist... but he only worked part time since he was 70.... his hygienist worked for one of those mill dental groups.... she said that she had a set time of 15 minutes to clean no matter how bad the teeth were... she did not like it, but had to do it for the money...


The rates are not that different, but the service is.....
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Old 01-22-2016, 03:14 PM   #36
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But won't most dentists charge you a much higher rate than the one negotiated by the insurance company?
Most dentists who have agreed to take a particular insurance, say Delta for example, as payment in full as part of their PPO plan, will in fact charge someone else ,who does not have that plan, more than they charge the Delta patient.

Many dentists sign up with multiple INSCOs and don't have a clue what they get paid by each one. INSCO "A" might pay 650 for a crown, "B" 500, and the patient with no insurance might pay 1100.

The trend over the last 5 years has been for the reimbursements from the PPO plans to go down, even though the cost of delivering the service has been going up.
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Old 01-22-2016, 03:31 PM   #37
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With some periodontal issues to stay on top of I'd been having cleanings done alternating between what amounted to a franchise dental outfit with pretty much a revolving door of staff, and a bit more of a top shelf periodontal practice. First place had some very good dentists and hygienists at times, other times not so much. Second one, the periodontal practice, had staff that was more likely to be there a while, and I felt a lot less like I was being hurried through the process to free up a chair. Price for services was pretty much the same between the two, and can't say I noticed a great difference in cost with or without insurance either. I've inquired about discounts for cash, etc. but generally get no response at all to that, don't suppose the front desk has the authority to dispense discounts. But even with more frequent dental care needs, I don't see that insurance does anything to help with costs, at best it simply displaces them to a different row in the spreadsheet and over time.
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Old 01-22-2016, 03:46 PM   #38
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My dentist is good. He only takes PPO insurance, not HMO, because PPO reimburses more. I am running without insurance as of mid December - but I remember the EOBs from the insurance company... There was about a 20% difference on most things between reimbursement rates and charges. So negotiated rates are real and significant.

I haven't figured out a way to get negotiated rates without insurance. The best my dentist will offer is 5% off the non-negotiated rates for cash payments.
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Old 01-22-2016, 04:00 PM   #39
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As the OP of the thread REWahoo linked I can tell you what I found.

There's no good solution ... We opted to self insure ... some dentists offer a discount for cash payment... but only if you ask. .
+1 to all of these.

As youngish ERs, there were no good choices and certainly none that allowed us to stay w a dentist we liked. DW and I have pretty good teeth/dental health, and both kids are through with orthodontia .. so we're writing checks for cleanings and the like. Total annual cost for those for family of 4 (w cash discount) was less than the premiums we could find.
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Old 01-22-2016, 04:08 PM   #40
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My dentist is good. He only takes PPO insurance, not HMO, because PPO reimburses more. I am running without insurance as of mid December - but I remember the EOBs from the insurance company... There was about a 20% difference on most things between reimbursement rates and charges. So negotiated rates are real and significant.

I haven't figured out a way to get negotiated rates without insurance. The best my dentist will offer is 5% off the non-negotiated rates for cash payments.
I have heard of some offices creating what they call "in house" plans, meaning that they'll provide some of those discounts even if you aren't in a plan. If you really want to look, you might try visiting dental office websites and see if they advertise such a program. Of course, you are still faced with leaving someone you trust (hopefully) and see eye-to-eye with, for an unknown entity.
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