Can't afford dentist.. Can anyone help me find dental insurance?

[Mr.Ritz]

So a few years back I had went to the dentist the first time in a long time. Ended up having 1000 dollars of work done had to finance it and everything. I only work part time

After that experience I was like ok gotta get dental insurance. So I did though my health company for 20 bucks a month. I went to my next cleaning all happy it was going to cover the cleaning, xrays and any work done. I gave them my insurance card and for whatever reason they couldn't figure out what it would cover. Not sure why it was a major insurance company. I say well its supposed to cover cleanings xrays and any work done.

Well, for whatever reason I get a call a few days later saying it only covered about 40% of the bill. The cleaning was supposed to be free and so were the xrays but the dentist charged way over what my insurance would pay. So in the end the insurance only paid out what I had put in. Worthless really..

So I stop going to the dentist again because I was so angry about the insurance. Well, here I am my tooth hurts and I damn well know if I go to the dentist without insurance I am looking at at least a 300 dollar bill..

I am looking at dental insurance again and most of it wont cover me for 6 months besides a cleaning. I know if I get the cheap stuff the dentist will prob tell me I need to get the tooth fixed before 6 months.. Pressure me to fiance something I can't afford.

There is another plan I was looking at that is 32 dollars a month vs 30 but covers everything starting now. But xrays are only 50%..

Just so confused on't want to get screwed again.

 

[ScaredyCat22]

If your insurance was through a major carrier it sounds like the reason you had to pay so much is because you may have chosen a dentist that was not a participating provider. Most dental insu has stipulations regarding how much they will pay or whether they will pay at all if you see a dentist that is not a part of their provider network.

 

[Mr.Ritz]

If your insurance was through a major carrier it sounds like the reason you had to pay so much is because you may have chosen a dentist that was not a participating provider. Most dental insu has stipulations regarding how much they will pay or whether they will pay at all if you see a dentist that is not a part of their provider network.

No, the dentist was in network. He just charged more than what the fee schedule allowed.

 

[FearfulInMA]

The dentist did what is called 'balanced billing'. This is allowed for out of network dentists, but is generally not allowed (by the terms of the dentist's contact with the insurance company) for in-network dentists. I'm not sure where you are, but this is how it usually works in the US. The whole point of an in-network dentist is that they have agreed to a rate with the insurance company. The big caveat to this is that it sounds like it was maybe not clear to you exactly what the coverage was - most dental plans only cover a portion of services up to a certain amount. When it's though a health insurance company that may be even more limited. If you are looking for new insurance, it's important to ask for the evidence of coverage and also annual maximums so that you know exactly what is covered. You can also ask for a list of in-network dentists - my guess is that, if the previous dentist couldn't figure out the coverage it was because they weren't truly in-network for your plan.

I know this is a lot of info (I work in health insurance) so feel free to ask more questions of you have them.

 

[Mr.Ritz]

The dentist did what is called 'balanced billing'. This is allowed for out of network dentists, but is generally not allowed (by the terms of the dentist's contact with the insurance company) for in-network dentists. I'm not sure where you are, but this is how it usually works in the US. The whole point of an in-network dentist is that they have agreed to a rate with the insurance company. The big caveat to this is that it sounds like it was maybe not clear to you exactly what the coverage was - most dental plans only cover a portion of services up to a certain amount. When it's though a health insurance company that may be even more limited. If you are looking for new insurance, it's important to ask for the evidence of coverage and also annual maximums so that you know exactly what is covered. You can also ask for a list of in-network dentists - my guess is that, if the previous dentist couldn't figure out the coverage it was because they weren't truly in-network for your plan.

I know this is a lot of info (I work in health insurance) so feel free to ask more questions of you have them.

Well, what pisses me off is they didn't tell me they were out of network. It was through one of the major health insurance companies here. They could have looked at the card and told me they were out of network. Instead they just said they couldn't get a hold of my insurance company for some reason and proceeded to charge me for work that I thought was covered. Instead of do the right thing and wait until they knew what was going to be covered. No, they decided I needed to get the work done TODAY because they would have to cancel the appointment.

With that in the past the two plans I am looking at now are Humana dental. One plan is 20 dollars but benefits do not kick in for 6 months and another plan is 32 but I can use it starting 1st of next month..

The 20 dollar plan says it covers cleanings 100% and xrays 100% while the 32 dollars plan only covers 50% of xrays. I think overall the 20 dollar plan would give me the most value but my tooth hurts today :/

I think both plans max out at 1000 a year. Not sure since the 32 dollar plan says it covers 2 fillings a year if that is towards the 1000 or not.

Is there anything that keeps me from getting the 32 dollar plan and switching to a 20 dollar plan down the road?

 

[FearfulInMA]

It's not always possible to tell from an insurance card (just be looking at it) if a provider is in network because each insurer has different and with different networks. It's ultimately the patient's responsibility to contact her/his insurer to see if a provider is in network and what the cost-sharing would be. This is not to say that dental offices don't normally check this (because it is in their best interest to get paid and to be able to give this information to the patient), but ultimately the responsibility is the patient's. I'm not saying any of this to say that what happened was your fault, but rather to empower you to get all of the information you deserve to have from your insurer.

That being said, I'm sorry you had the experience you did. What I can tell you is that in every plan I've ever seen all services count towards the maximum (even cleanings). So, anything that the insurers pays out counts. For me, because I have bad teeth, this usually means that I have to out of pocket for my second cleaning of the year because I have maxed out my benefit. In terms of getting one plan now and another later, you may only be able to change plans 1x/yr, but this is something you may want to call and ask about.

Is this information helpful?

 

[Mr.Ritz]

It's not always possible to tell from an insurance card (just be looking at it) if a provider is in network because each insurer has different and with different networks. It's ultimately the patient's responsibility to contact her/his insurer to see if a provider is in network and what the cost-sharing would be. This is not to say that dental offices don't normally check this (because it is in their best interest to get paid and to be able to give this information to the patient), but ultimately the responsibility is the patient's. I'm not saying any of this to say that what happened was your fault, but rather to empower you to get all of the information you deserve to have from your insurer.

That being said, I'm sorry you had the experience you did. What I can tell you is that in every plan I've ever seen all services count towards the maximum (even cleanings). So, anything that the insurers pays out counts. For me, because I have bad teeth, this usually means that I have to out of pocket for my second cleaning of the year because I have maxed out my benefit. In terms of getting one plan now and another later, you may only be able to change plans 1x/yr, but this is something you may want to call and ask about.

Is this information helpful?

Thanks for the help.. So this time I decided to pick a cheap in network only plan where I have to pick a primary care dentist from the start. I wont be able to meet them or anything so I have to get it right the first time. I started going through the list of 100's and google maps each one. Sadly most of them have no reviews or have awful reviews as worst dentist ever. I suppose this is to be expected with bottom of barrel plan but I did find 2 dentist out of 100.. Still I would like to find more great reviewed dentist. Anyway to find a good one on such a crappy plan?

 

[FearfulInMA]

Can you call the dental office and ask to meet with the dentists? tell them you are trying to find the right dentist and that you'd just like to chat. Many office will do that with no charge.

 

[Angeldove]

Have you looked into Care Credit? I'm using it to pay for my dental work. I could technically get it all done this year and just charge it all but I'm deciding to do a little work at a time - as long as nothing is broken and that I do not have any pain.

I just had a root canal and crown done - I put that on my card. I now have 18 months to pay it off before interest kicks in (and I would have to owe all of the back interest too). I'm paying $50 a month to have it paid off in time.

Care Credit allows you to have work done and then decide how long you want until interest kicks in (I think you can go up to 24 months but at a higher interest rate).

The other thing that helps is that my insurance gets me discounted rates on work at my dentist - which is in-network. That alone helps me to save a lot of money, so if your insurance is getting you discounted rates, count that as part of the money saved. Not just what they will pay for you.

You have to be careful of finding an in-network dentist - some will be dishonest and just not tell you. Most insurance sites have a members log in area - that's how I found my dentist: I set up an account, logged in, and they sent me all the dentists that were in my network in my town. Thankfully the one a few blocks away (I can walk to the place) is in-network.