Crappy dental 'insurance'

[braumeister]

A subsidized dental plan from an employer can still be a good deal, so you shouldn't reject it out of hand.

We have one from DW's former employer. Our wonderful dentist has had his hands full with us due to an accident DW suffered, and his total billing for the two year period 2014-15 was close to $5,000.

Of that $5,000, the insurance paid just under $1,600 and we paid the rest. But our premiums were only $720, or roughly half what they paid.

 

[athena53]

A subsidized dental plan from an employer can still be a good deal, so you shouldn't reject it out of hand.

I agree; I'm betting that premiums are lower for employer plans because the covered employees will include a large number who rarely go to the dentist unless they have a problem, so they're cheaper to insure. Those of us who buy private plans are more likely to go for the cleanings and probably anticipate an occasional major repair based on past experience.

 

[Amethyst]

It sounds like you have 2 insurances: your regular health insurance, and your dental plan. Did the dentist bill your primary insurer, or your dental insurer?

Our primary insurance is Federal BC/BS, which has a tiny dental benefit for preventive care. In addition, we carry Humana Federal Dental insurance, which pays about 40% of "reasonable/customary" charges for restorations. The dental practice charges us a co-pay they agreed on with Humana. We pay the Humana co-pay up front at time of service. For preventive care, we pay nothing up front.

But there is always, always a hassle that makes it look like we are being charged much more than agreed on. By law, the dental office must bill the "primary" insurer first. Then BCBS sends an EOB denying the claim. Then the dental office must submit the BCBS EOB to Humana along with their claim.

Unfortunately, the dental office never seems to be able to get past the BCBS refusal. Then their computer sends me a threatening letter for non-payment. Then I have to send MY copy of the BCBS EOB to the dental billing office, requesting that they send it to Humana along with their claim. For complicated bills, like Mr. A's implant, it can take months to get this straightened out, and meanwhile, I get a threatening letter every month.

Just wondering if this has any bearing on your situation.

Amethyst

 

[rodi]

I still say it's too soon to know if the coverage was worth anything. An EOB is *not* a bill. States it right on the EOB. What will be interesting is the bill from the dentists office.

Since the dentist is out of network, they balance bill the entire amount, or a part of the amount.

 

[HadEnuff]

It sounds like you have 2 insurances: your regular health insurance, and your dental plan. Did the dentist bill your primary insurer, or your dental insurer?

Our primary insurance is Federal BC/BS, which has a tiny dental benefit for preventive care. In addition, we carry Humana Federal Dental insurance, which pays about 40% of "reasonable/customary" charges for restorations. The dental practice charges us a co-pay they agreed on with Humana. We pay the Humana co-pay up front at time of service. For preventive care, we pay nothing up front.

But there is always, always a hassle that makes it look like we are being charged much more than agreed on. By law, the dental office must bill the "primary" insurer first. Then BCBS sends an EOB denying the claim. Then the dental office must submit the BCBS EOB to Humana along with their claim.

Unfortunately, the dental office never seems to be able to get past the BCBS refusal. Then their computer sends me a threatening letter for non-payment. Then I have to send MY copy of the BCBS EOB to the dental billing office, requesting that they send it to Humana along with their claim. For complicated bills, like Mr. A's implant, it can take months to get this straightened out, and meanwhile, I get a threatening letter every month.

Just wondering if this has any bearing on your situation.

Amethyst

Wow. in 38 years of practicing dentistry I don't think I've ever run across a medical insurance provider who covered anything for any dental procedure. Are you saying that the BC/BS Medical plan is the primary insurer for non-preventive procedures that they won't cover?

 

[Texas Proud]

I still say it's too soon to know if the coverage was worth anything. An EOB is *not* a bill. States it right on the EOB. What will be interesting is the bill from the dentists office.

Since the dentist is out of network, they balance bill the entire amount, or a part of the amount.

They balanced billed everything except for fluoride..... I will be dropping this insurance and checking what I had two years ago... it paid 100% of the cleanings....

 

[Texas Proud]

It sounds like you have 2 insurances: your regular health insurance, and your dental plan. Did the dentist bill your primary insurer, or your dental insurer?

Our primary insurance is Federal BC/BS, which has a tiny dental benefit for preventive care. In addition, we carry Humana Federal Dental insurance, which pays about 40% of "reasonable/customary" charges for restorations. The dental practice charges us a co-pay they agreed on with Humana. We pay the Humana co-pay up front at time of service. For preventive care, we pay nothing up front.

But there is always, always a hassle that makes it look like we are being charged much more than agreed on. By law, the dental office must bill the "primary" insurer first. Then BCBS sends an EOB denying the claim. Then the dental office must submit the BCBS EOB to Humana along with their claim.

Unfortunately, the dental office never seems to be able to get past the BCBS refusal. Then their computer sends me a threatening letter for non-payment. Then I have to send MY copy of the BCBS EOB to the dental billing office, requesting that they send it to Humana along with their claim. For complicated bills, like Mr. A's implant, it can take months to get this straightened out, and meanwhile, I get a threatening letter every month.

Just wondering if this has any bearing on your situation.

Amethyst

I do not know why you have to go through that....

Our medical insurance only covers dental if there was an accident.... IOW, something knocked out a tooth... normal cleanings, fillings, crowns etc. would not be covered....

 

[Amethyst]

Wow. in 38 years of practicing dentistry I don't think I've ever run across a medical insurance provider who covered anything for any dental procedure. Are you saying that the BC/BS Medical plan is the primary insurer for non-preventive procedures that they won't cover?

I'm describing the tortured claims process which the billing office claims they must, by law, pursue. BCBS pays a small preventive care benefit, and I think there may be something for emergencies that are deemed more medical than dental. No restorations are covered.

 

[HadEnuff]

I'm describing the tortured claims process which the billing office claims they must, by law, pursue. BCBS pays a small preventive care benefit, and I think there may be something for emergencies that are deemed more medical than dental. No restorations are covered.

my question is whether the BCBS is considered the "primary" dental insurance. IF they are, then the claim has to go through them first, even if they don't pay. If that's the case, then the provider has to jump through that hoop first, wait weeks for the denial, and then file to the secondary who actually will pay something, but not for another "few weeks".

 

[HadEnuff]

Amethyst, I think I know what's going on in your case. If your office accepts a lot of insurance PPOs, then they have a fee schedule that moves all over the place depending upon which contracts they've signed up for. They probably have another one for the folks who don't have any insurance. The INSCO will pay their agreed upon fee, or the charged fee, whichever is lower, so the provider, in order to make sure they get the maximum fee, will submit a fee higher than any of the agreed upon fees and let the insurance company knock it down. Since you are getting a dunning letter before your secondary provider has knocked it down, you are seeing the big number. It's a goofy game. One, as a dentist, I never played.
But, because I never played along with the INSCOS, they were constantly trying to make my life miserable by sending playing with my claims, "losing" submissions, denying claims that once we contested they would pay, but in the meantime my staff was wasting time and my cash flow was compromised.
The main thing that dental insurance "insures" is often the INSCOS cash flow. Everything else is secondary to that.
Frankly, having to deal with them is the biggest reason why I'm OUT of the profession in 2 weeks. I wouldn't mind just dealing with patients and fixing teeth, but the INSCOS have left me with no more hair to pull out.

 

[athena53]

Frankly, having to deal with them is the biggest reason why I'm OUT of the profession in 2 weeks. I wouldn't mind just dealing with patients and fixing teeth, but the INSCOS have left me with no more hair to pull out.

Wow- I knew doctors had these headaches but not dentists. We got Delta Dental for DH because our dentist recommended them and they've been fine. For people who have enough dental issues to want insurance, it might be good to ask your dentist which companies are best to work with.

 

[Amethyst]

If your office accepts a lot of insurance PPOs, then they have a fee schedule that moves all over the place depending upon which contracts they've signed up for. They probably have another one for the folks who don't have any insurance. The INSCO will pay their agreed upon fee, or the charged fee, whichever is lower, so the provider, in order to make sure they get the maximum fee, will submit a fee higher than any of the agreed upon fees and let the insurance company knock it down.

Yes, that is an accurate description of what is going on. It took me many, many hours of bird-dogging with a certain type of pig-headed administrator, at the practice and at both insurance companies (They must all hire from the same pool) to figure it out. Each insurance company's administrators blamed the other one, and they both blamed the dental office. The dental office admins employed the phrase "It's your respon-si-bil-i-tee." Meanwhile, all I had were receipts for co-pays, and dunning letters threatening my credit rating.

But, because I never played along with the INSCOS, they were constantly trying to make my life miserable by sending playing with my claims, "losing" submissions, denying claims that once we contested they would pay, but in the meantime my staff was wasting time and my cash flow was compromised.

Over the past 10 years, our family has had a great many dental procedures. About $30,000 in co-pays alone, and I am pretty sure we ended up overpaying in the earliest years after the office stopped billing Humana directly, and went to the two-billing procedure.

It has long been apparent that our dental practice is pushing some of the staff's headaches onto the patients. They know that some of us cannot live with "threatening letters," although others probably ignore them. So now, when I get a letter, I dutifully pull out my own BCBS EOB, scan and email it to their billing office. And I check Humana's web site frequently to ensure the various claims are being turned in.

For those who are thinking, "Why didn't you change practices?" Well, I thought of it. I work out at the same gym as a dentist whose practice accepts Humana, and she told me the insurance is handled the same way at her practice!

.[/QUOTE]

 

[HadEnuff]

12 more days and I'm out...actually, I don't deal with the INSCOS anymore, I've sold the practice so I just work there. And that's 12 calendar days. Only 4 work days, and 3 of those are half-days. Happy Dance!

 

[GTFan]

Good for you doc, you sound like a dentist I would've been glad to have visited. Thanks for the insights on how your practice worked and the confirmation on how the dental insurance market is so crappy for unemployed folks.

 

[Amethyst]

Humana Federal's benefits are a little better than Delta's, last time I checked. For us, at any rate.

Swapping secondary insurers would not make any difference for us. The dentists at the practice don't deal with the insurers. The problems are clerical/administrative in nature. The admin and billing people in the practice are overwhelmed and testy, and the turnover is high.

Wow- I knew doctors had these headaches but not dentists. We got Delta Dental for DH because our dentist recommended them and they've been fine. For people who have enough dental issues to want insurance, it might be good to ask your dentist which companies are best to work with.

 

[gabrewer]

In most reading I've done on this topic I've found that the big thing you have to be aware of is that most dental plans -- both group or individual -- have a line somewhere in the policy entitled "maximum annual benefit" or something to that effect. This is the overriding cap on the total annual payout, regardless of what percentage is paid for what procedure. In most plans it is a surprisingly low amount -- somewhere between $1,000 and $2,000 per year. It is $1,250 in the group plan I used to be a part of. As another poster alluded to, dental insurance might be a good deal, especially if paid with pretax premiums, if all you need is a couple of routine cleanings per year -- basically a prepaid plan as routine checkups are supposedly "free". For the rest of us, it's a more dubious proposition. My experience has been if you have a big dental bills in a given year, you're still paying most of it out of pocket regardless of your insurance.

My wife and I last year decided to discontinue my group dental. It was just a budgeting issue, as the premiums on our regular health insurance increased. It was an interesting experience. Although it stings some to pay for routine checkups out of pocket, it seems that all the urgent recommendations for "deep scaling" and other assorted "treatment plans" are no longer forthcoming. This reinforces a suspicion I've always had that many dental practices have a person in the office whose job it is to determine how to get the maximum amount out of each patient's insurance benefits -- which means a lot of out of pocket expense as well.

 

[mn54]

dealing with ins. cos. is one of the biggest headaches and takes up more time for the front desk workers in a dental practice. It is one of the reasons I RE. It is also the reason more dental offices are deciding not to be participating providers for ins. cos. The dentist will fill out the ins. forms for you but will expect payment from the patient directly and any reimbursement from the ins will go to the patient.

 

[HadEnuff]

dealing with ins. cos. is one of the biggest headaches and takes up more time for the front desk workers in a dental practice. It is one of the reasons I RE. It is also the reason more dental offices are deciding not to be participating providers for ins. cos. The dentist will fill out the ins. forms for you but will expect payment from the patient directly and any reimbursement from the ins will go to the patient.

Brothers in arms....

 

[Texas Proud]

Well, called to cancel the dental insurance and was told I had to do it through the marketplace since that is where I signed up...


I was able to just cancel dental.... if you go on the site and try and cancel it will cancel ALL your insurance, including healthcare...

 

[Moemg]

I have Met life dental federal insurance and it has been great . They process claims fast and then send the claims to federal blue cross +blue shield so most of my procedures are almost fully covered . I went to a new Dentist recently and the insurance person said "That is great insurance ".

 

[AnIntentionalRoad]

The state of Illinois now requires all children are covered by dental insurance. That's the only reason we have the crappy plan 5hat we have. $60/mo for basically little benefit.

Sent from my SM-T237P using Early Retirement Forum mobile app

 

[explanade]

I have Met life dental federal insurance and it has been great . They process claims fast and then send the claims to federal blue cross +blue shield so most of my procedures are almost fully covered . I went to a new Dentist recently and the insurance person said "That is great insurance ".

That must be through an employer?