Crappy dental 'insurance'

[Texas Proud]

I know there have been many threads on dental insurance and how it is not really insurance etc. etc.... I know about that etc., but will complain about something else...


I decided to buy dental insurance this year for the 4 of us... cost about $120 per month... it states that it will pay 100% of normal preventative starting when we purchase the insurance.... both in and out of network...

So, kids went in January (their normal time, had been scheduled 6 months earlier).... normal stuff, I do not even believe any X-rays...

I just go my EOB and to my surprise the amount they will pay is only about 40% of the bill... WHAT They agree on the three charges being submitted, but their 'normal' cost is so much lower than what you can get it for around here... they are paying their 'normal' charges....


Now, I have called around and the price my dentist is charging is almost the same as others... I did not call any of those dental mill places as they do not provide the level of care that I think we need....

Will be dropping this insurance pretty quickly....

 

[HadEnuff]

did they pay out in benefits as much as you paid them in premiums?

 

[big-papa]

Was your dentist "in-network"?
Not surprised - my wife, daughter and myself all go to different dentists. Back when I was looking for private insurance, it was just about impossible to find somebody "in-network" for all 3 of us. Now that I'm w*rking again that just doesn't seem to be problem with the insurance we get through my employer.

 

[pb4uski]

I had dental insurance when I was working. Our dentist who we had used for years and was a childhood friend was not in network.... we ended up paying the difference between what he charged and the insurance company paid... about $25/visit as I recall. Annoying but not the end of the world.

 

[rodi]

Is your dentist "balance billing". I remember the first time I got an EOB - I was shocked at the difference between the charge and the reimbursement. But I was never billed for the difference.

This may be a case where having insurance locks in the lower negotiated price.

 

[FUEGO]

Sounds like they aren't treating your dentist as in network. Some of the less expensive dental plans have limited networks.

I was just perusing the dental plans available through the healthcare.gov exchange and decided not to buy any. Even though it's only $22/mo ($270/yr), that's $70 more than I'll pay for 2 cleanings with my dentist's $99 special. If I get a cavity, I'll pay the $100-150 out of pocket. with insurance it would have been ~$100 after deductible, so I would still be better off without insurance unless I get more than 1 cavity.

 

[wolf]

I know there have been many threads on dental insurance and how it is not really insurance etc. etc.... I know about that etc., but will complain about something else...


I decided to buy dental insurance this year for the 4 of us... cost about $120 per month... it states that it will pay 100% of normal preventative starting when we purchase the insurance.... both in and out of network...

So, kids went in January (their normal time, had been scheduled 6 months earlier).... normal stuff, I do not even believe any X-rays...

I just go my EOB and to my surprise the amount they will pay is only about 40% of the bill... WHAT They agree on the three charges being submitted, but their 'normal' cost is so much lower than what you can get it for around here... they are paying their 'normal' charges....


Now, I have called around and the price my dentist is charging is almost the same as others... I did not call any of those dental mill places as they do not provide the level of care that I think we need....

Will be dropping this insurance pretty quickly....

Had similar experience many years ago. Only good dental insurance is the one provided by employers.

Talked to many dentists, receptionists. They could not recommend one
private dental carrier that was good.

 

[Texas Proud]

Was your dentist "in-network"?
Not surprised - my wife, daughter and myself all go to different dentists. Back when I was looking for private insurance, it was just about impossible to find somebody "in-network" for all 3 of us. Now that I'm w*rking again that just doesn't seem to be problem with the insurance we get through my employer.

Dentist is not in network.... however, I paid more for insurance that also would pay for dentist out of network...


I did change from the company I had two years ago (went without last year) who did pay for all charges... will see if I can go back to them...

 

[Texas Proud]

Is your dentist "balance billing". I remember the first time I got an EOB - I was shocked at the difference between the charge and the reimbursement. But I was never billed for the difference.

This may be a case where having insurance locks in the lower negotiated price.

Do not know... just got the EOBs...

I do know that my old dentist billed for fluoride and the insurance would not pay and I did not get a bill... I think this is the same with current dentist... however, I do not see the dentist eating $120 of charges... we will see...

Insurance does not lock in the lower rate since our dentist is not in any network....

 

[rodi]

If all you have is an EOB - you don't know what your bill will be. I'd wait and see.

 

[bUU]

Dentist is not in network.... however, I paid more for insurance that also would pay for dentist out of network...

We also have insurance that would pay for a dentist out of network, but not at the same level of reimbursement as dentists in-network.

 

[HadEnuff]

We also have insurance that would pay for a dentist out of network, but not at the same level of reimbursement as dentists in-network.

I will ask you the same question I asked the OP:
Are they paying out more in benefits than you are paying them in premiums?

 

[bUU]

I will ask you the same question I asked the OP:
Are they paying out more in benefits than you are paying them in premiums?

Why would anyone think they would do that?

 

[athena53]

I will ask you the same question I asked the OP:
Are they paying out more in benefits than you are paying them in premiums?

DH and I actually beat the system on this. Last November, after 18 months of premiums (I estimate $700 total) and no claims except for a couple of cleanings a year, we decided to cancel the policy. Near the end of November, DH thought he might be developing problems in one molar. I was able to reinstate coverage by paying the premium before the end of the month. It turned into a nasty problem that required a root canal and so far the insurer has forked over about $1,000. (That excludes nitrous oxide at $50 a pop, which makes the experience far more bearable for DH but is not covered for those treatments.)

Now I'm wondering whether to cancel again since the work is done and all is well!

 

[Stillninetofivin]

Our marketplace plan coverage goes up each year. I've got an upper molar that's about to be replaced and I'm happy to see a bump in what they're covering even though the premium is the same as last year.

 

[mickeyd]

Will be dropping this insurance pretty quickly....

As has been mentioned here many times, "dental insurance" is more like pre-paid coverage than real "insurance". A lot of money has to be paid out prior to any claims (agent commission, management fees, insurance company take etc) which only leaves only so much for the dentist.

Self insure this one.

 

[Texas Proud]

We also have insurance that would pay for a dentist out of network, but not at the same level of reimbursement as dentists in-network.

They are supposed to pay necessary and reasonable.... not from a different payment schedule...

I will ask you the same question I asked the OP:
Are they paying out more in benefits than you are paying them in premiums?

I had calculated that my premiums for the year would be more than what they would pay out if nothing happened.... but something almost always happens with DW... she had bad teeth... went to have 4 pulled today and will be having implants...

Total premiums would be in the $250 range over cleanings etc... But, if they are going to be pay half of what they are supposed to, that goes up to $1100... might as well not have insurance...

 

[bUU]

We also have insurance that would pay for a dentist out of network, but not at the same level of reimbursement as dentists in-network.

They are supposed to pay necessary and reasonable....

The coverage is based on reasonable and customary, but not necessarily 100% coverage, not even in-network.

not from a different payment schedule...

I don't know what kind of dental insurance you have; I am talking about my dental insurance. Out-of-network, preventive services are subject to balance billing; basic services are covered at 80%; and major services are covered at 50%. A $50 pp deductible applies.

 

[Texas Proud]

The coverage is based on reasonable and customary, but not necessarily 100% coverage, not even in-network. I don't know what kind of dental insurance you have; I am talking about my dental insurance. Out-of-network, preventive services are subject to balance billing; basic services are covered at 80%; and major services are covered at 50%. A $50 pp deductible applies.

My current insurance does have $50 deductible, but not on routine cleanings etc.... and they say they pay 100% in or out of network for preventive care... (as I said before, their coverage is the same in network and out of network... the only thing that I can see for in network is that the dentist has agreed to their price schedule so you cannot be balance billed).. yes, reasonable and customary.... but what their prices the EOB showed is not even close to any dentist that I called around me... my dentist said they check more than I do to make sure they are charging close to what others charge...

 

[bUU]

Check the dentists who service mostly lower-income areas, or who operate out of dental schools. Their prices tend to be much lower, and account for the difference between R&C and the price list of preferred dentists.

 

[swakyaby]

What bUU states regarding insurance payments being different for in-network vs out-of-network dentists sounds pretty standard in the dental insurance industry. Insurance tends to pay less to out-of-network dentists in part because there is no prior agreement on charges, leaving you, the subscriber responsible for the balance. The term "necessary and customary" leaves a lot of discretion to your insurance company to disallow or lower payments to out-of-network dentists--you just don't know! Stick to in-network dentists, or if none are convenient, I would research other dental insurance that have a better selection of in-network providers.

 

[Texas Proud]

What bUU states regarding insurance payments being different for in-network vs out-of-network dentists sounds pretty standard in the dental insurance industry. Insurance tends to pay less to out-of-network dentists in part because there is no prior agreement on charges, leaving you, the subscriber responsible for the balance. The term "necessary and customary" leaves a lot of discretion to your insurance company to disallow or lower payments to out-of-network dentists--you just don't know! Stick to in-network dentists, or if none are convenient, I would research other dental insurance that have a better selection of in-network providers.

I agree that in network would probably not have any extra.... but that is not what their brochure says... it says reasonable and customary at 100% in network or out of network.... their payment is far from the customary charges by dentist around here....

I did use a different insurer a couple of years ago and they paid 100% of my current dentists charges... again, I am paying a higher premium for them to reimburse out of network docs the same as in network...

I will be dropping this company and seeing if I can sign up for the one I had two years ago... if not, I will go without as I did last year....

 

[bUU]

I agree that in network would probably not have any extra.... but that is not what their brochure says... it says reasonable and customary at 100% in network or out of network....

I've never seen such a thing. It would be a great service to us in retirement to have a dental plan that paid 100% in network or out... what insurance plan is it?

 

[HadEnuff]

trying to buy a single customer dental insurance policy that will pay out more than it takes in is unlikely to work out. In order to survive, insurance companies have to take in more than they pay out. Unless you have the clout of joining a large group of customers, so the insurance company has a chance of some of the premium payers actually NOT using the service (so they can collect more in premiums than they pay out in benefits), you are probably better off self insuring.

Also, remember, that when an employer provides access to dental insurance, the premiums are paid with pre-tax dollars, which again helps in making the product more cost-effective.

 

[itsmyparty]

We were offered 5 different dental plans as part of the retirement package from the former company. Talked to the billing person at our dentists office - she reviewed and said we are better off just paying ourselves as each plan had bad clauses ... And plans expensive. Eg. One had a waiting period of 6 months after diagnosis of infected tooth...with no retroactive coverage. right now we just need quarterly teeth cleaning and the odd xray...and get a 20% senior discount! We are lucky the former employer gives us about $4000 a year to pay premiums', medical, prescription and dental costs not covered by medicare and supplemental plans. Know some big dental expense could arise .. But no confidence that any of the offered plans would actually pay. Had such a goid plan when working - wish that was still offered!




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