Dental Insurance - RANT

[Donald]

Recently got a root canal. Dentist is "insurance friendly" meaning that file the insurance claim, but expect full payment from the patient at time of service. This makes the dentist "our of network".

Insurance pays 50% for this kind of dental work to a max of $1000 per year.

If your dentist is out of network then they pay 50% of the negotiated fee an in network dentist would accept.

My dentist charged $2000 for the root canal. They had a range of $1600 to $2000 and my root canal ended up being a little more complex and costly.

So the dental insurance company has a negotiated rate for a root canal of $484. They cover 50% or $242.

With a rare of $484 for a root canal it's no wonder they have few in network dentists.

 

[Rand]

yeah modern dental insurance is more like a coupon.

about 10-20% of the total

 

[tbm5690]

It didn't take me much to figure out that I shouldn't pay for dental insurance premiums...the break-even point between this and self-insuring doesn't take long to hit.

 

[CarLuver]

My cousin is a dentist. he told me that a big local software companies dental insurance was only going to give him $39 for a cleaning. he told them to take a hike and dropped all the patients on that provider. he said he rather close his shop then work for free .

after a little while he heard the insurance company had to raise their pay rate because no one would take their insurance . even after they did, he still does not want anything to do with them .

 

[99Saturn]

Dental insurance to blame or the employer that opted to offer that insurer/insurance?

 

[2strokeNorthstar]

Find a new dentist that will take your insurance. Medical insurance in the US is all a racket.

 

[SubieRubyRoo]

Recently got a root canal. Dentist is "insurance friendly" meaning that file the insurance claim, but expect full payment from the patient at time of service. This makes the dentist "our of network".

Insurance pays 50% for this kind of dental work to a max of $1000 per year.

If your dentist is out of network then they pay 50% of the negotiated fee an in network dentist would accept.

My dentist charged $2000 for the root canal. They had a range of $1600 to $2000 and my root canal ended up being a little more complex and costly.

So the dental insurance company has a negotiated rate for a root canal of $484. They cover 50% or $242.

With a rare of $484 for a root canal it's no wonder they have few in network dentists.

That sucks, but is about in line what my friend (who’s a doctor) previously told me. He said basically if insurance was not involved, he could literally charge 20% of what the rate that gets billed to insurance is and still break even.

Patients who don’t have insurance, this is what he does, and frequently writes off balances left over for older patients on limited incomes. The worst part is he said he sees 3 times as many patients as before Obamacare, yet takes home the same money as before. So it’s obviously not the doctors making the extra money…

 

[racer12306]

yeah modern dental insurance is more like a coupon.

about 10-20% of the total

I don’t call it dental insurance, I call it the dental discount program.

 

[Leo99]

I don’t call it dental insurance, I call it the dental discount program.

Same thing with eyeglass insurance.

 

[Donald]

Find a new dentist that will take your insurance. Medical insurance in the US is all a racket.

It's a struggle in southern DE to find a decent dentist who is accepting new patients as there are tons of retirees moving to the area. I want to "like" my dentist and feel they are on the same page as me with it comes to caring for my teeth. (Small hands is a bonus).

 

[jeepman3071]

Find a new dentist that will take your insurance. Medical insurance in the US is all a racket.

Insurance itself is a huge scam. I worked in the insurance industry, their whole business is based on making at least double in profit for what they pay out in claims.

 

[andrew_j]

Insurance itself is a huge scam. I worked in the insurance industry, their whole business is based on making at least double in profit for what they pay out in claims.

Is that a scam to profit in a free enterprise system? Should our government take over?

Pros and cons for sure in our system , this one falls into a con I agree however so many great things besides.

 

[zzyzzx]

Insurance pays 50% for this kind of dental work to a max of $1000 per year.

You need a better dental plan. A policy with an annual limit that low isn't going to do much for you. The higher limit policies often have lower copays and better reimbursement rates for the dentists. I think my dental plan has an annual limit of $2500/year (or maybe $2000) but if you think you are going to need a root canal and a crown or an implant there are better policies available. They aren't cheap at your age, like $100 - $120 month.

 

[zzyzzx]

It's a struggle in southern DE to find a decent dentist who is accepting new patients as there are tons of retirees moving to the area. I want to "like" my dentist and feel they are on the same page as me with it comes to caring for my teeth. (Small hands is a bonus).

You are going to have to drive to see a dentist where you live. If I lived near you, I would probably go to the same Annapolis dentist that I go to now.

 

[Pablo]

My medicare advantage plan (Humana) has dental insurance. If it didn't I would just pay cash.

 

[Hillbilly Deluxe]

This is pretty much the norm for all dentists (worth going to) today. I don't know of a private practice (i.e.: not a retail storefront chain dental clinic) that is in network for any insurance around my area THAT IS BOOKING APPOINTMENTS LESS THAN 8-12 MONTHS OUT.

Here's where you battle this- it's with your employer/HR. Tell them that there are no dentists that take insurance. IMO, the best way around this is for companies to contribute to an FSA account for you in the amount of an agreed-upon amount that the dental insurance would pay out for you plus the premiums your employer would pay. This would most likely work out better for the employee, plus they can contribute money that is not Federally taxed to this FSA to assist with dental bills and more.

 

[Nukeman7]

Like HD states above, the real issue is that you are limited to using an "In Network" dentist to get a reasonable co-pay from the insurance company. The negotiated rates for "In Network" providers are so low that very few dental practices can survive unless they run patients through like herding cattle, hence the 8-12 month waitlist for an appointment. As such, IME, you only have less desirable providers willing to partake as preferred "In Network" dentists.

So if I interpret the situation correctly, the OP had to pay ~$1758 out of pocket while his insurance only covered $242. Hardly worth paying for insurance as that $242 would have been offset by 2 to 3 months of the insurance premium payments.

 

[zzyzzx]

Fun fact: My dentist just dumped a bunch of dental insurance companies. I happened to switch jobs at the same time and just happened to switch to one of the dental insurance companies that wasn't being dumped.

 

[zzyzzx]

Insurance pays 50% for this kind of dental work to a max of $1000 per year.

If your dentist is out of network then they pay 50% of the negotiated fee an in network dentist would accept.

My dentist charged $2000 for the root canal. They had a range of $1600 to $2000 and my root canal ended up being a little more complex and costly.

So the dental insurance company has a negotiated rate for a root canal of $484. They cover 50% or $242.

IMO, $2000 seems like a lot for a root canal, even for a molar.

Anyhow, what's the premium for this particular dental policy that you have?

 

[Nukeman7]

$2000 is the going rate now. I had a root canal in February 2023 and the billed amount was around $1980. Fortunately, my dentist and orthodontic surgeon were both "In-Network" so my out-of-pocket was ~$400.