A case for dental insurance

[dick0236]

I just read some posts concerning the very high cost of dental procedures on a different thread. I didn't want to "muddy" up that thread, so I'm starting this one.

When you recieve dental care without insurance you are at the mercy of the dentist and must pay his/her "retail rate" unless you can negotiate a discount with him. A strong dental insurer, such as Delta Dental, negotiates reimbursement rates with participating dentists that are 30-50% below his/her "retail" rates. Here is a hypothetical example:

A crown "retails" for $1200. The dental allowance is $720(60%). I pay $360(50% of the allowance and Delta Dental pays $360). The dentist must contractually "eat" $480($1200-$360-360=$480). The dentist receives $720. That is what the dentist really thinks the crown is worth.

How does the premium I pay each month ($54/mo, $648/yr) figure into this. My wife and I each routinely see the dentist twice/yr for cleaning, exam, x-rays. The cost for each of those visits is about $150. 2 visits for me and 2 visits for wife total $600. These procedures are paid 100% by my plan, so that takes care of the premium I pay annually.

All other services we receive require some co-pay, usually 50% of the NEGOTIATED rate. Even if we use 100% of our yearly allowance and have to pay all of our treatment cost, we still pay only theNEGOTIATED rate.

Dental insurance allows me to level out my yearly "preventative" cost AND forces dentists to discount their "retail" rates, just as health insurance forces doctors and hospitals to discount their "retail" rates.

Good dental care is very necessary for Valve patients, that's why I put this in the "Heart Talk" forum.

Incidentaly, I retired from this business 12 years ago, so I really "don't have a dog in the fight". These are my thoughts as to what works for me.

 

[skeptic49]

Thanks for posting this, Dick. Getting the benefit of the "negotiated" rate for services is very important. We'll be looking for some sort of dental plan in a few months when my partner's employer drops us as he turns 65. Anyone have an suggestions for reasonable dental plans?

Jim

 

[Cooker]

I go twice a year but I just had to push this weeks appointment out to November ....which does not make any diff ... but I was told by my hygienist to rinse with a good rinse twice a day to help keep bacteria at bay ? plus it keep my breath minty fresh ... good oral health is a must!!!

 

[EVELYN]

When Tyce retired last year, we opted to continue his dental insurance with MetLife Dental. Not the best plan in the world, and many dentista down here do not take it. We pay about $72 a month for the two of us and were seriously considering dropping it until earlier this year when he needed a new crown and again two weeks ago when he will need a root canal, post, and crown.....They pay 80% after the deductible of $350 individual....not great, but better than nothing. Our new dentist isn't inlove with MetLife, so he's not a participator, but we really like him, so have opted to pay the rest......ugh.

Soooo, think twice about Metlife Dental.

Evelyn

 

[Lisa in Katy]

I will admit that I hate to go to the dentist. Not because it hurts, but because in the past, the antibiotics really threw my INR into a tailspin. Because of that I skipped a few years, and I paid for it this year. However, I'm happy to say that the antibiotic that was used this year (can't remember the name, but it's on another post) didn't seem to affect my INR, so I am happy.

Between my regular visit and cleaning, a visit to a Periodontist to see if I needed a root canal, and two crowns and an extraction, I've had lots of recent experience with the dentist. He billed $2476, I paid $1053.40. Insurance paid the rest.

I pay $9.20 every two weeks, so I figure I am way ahead!

When you go to the doctor, they bill all patients the same so the EOB shows you the benefit of going to a network physician. However, when you go to the dentist, they adjust their charges based on their contract. Since both of these dentists are in my network, and charges were adjusted to reflect that, I don't know what the charges would have been if they had been out of network.

 

[Lisa in Katy]

BTW Evelyn, no dentist is in love with any dental managed care plan. They also have really good lobbying powers that protect them from getting dinged so bad for out of network visits, so it is not as necessary for them to be par as it would be a physician. United Dental has a good network for general dentists, but very limited for specialists.

 

[dick0236]

Skeptic 49...look for a strong insurer with a lot of subscribers. It has the clout that makes the majority of dentists want, or need, to participate. Dentists see the plan as a large pool of potential patients.....and the negotiated rates are fair, regardless of how some dentists will scream otherwise.

In Kentucky, Delta Dental, has always had a strong subscriber base. Dentists know this and generally want to get a piece of the Delta Dental pie. That type of large subscriber base is not enjoyed by ALL insurance companies. Look at several good, large dental plans. Look at premium, co-insurance %'s, max yearly benefit and if they have negotiated provider service contracts. That's where you will really save money. It really does not save you any money if the insurer will accept whatever the dentist charges.

 

[Rich]

Dick,
With our current(soon to be gone)GM health benefits, we have Delta Dental as well.
I know they have several different plans, such as PPO, Premier, etc.
Which plan do you have and does the monthly premium you quoted cover just you, or you and your spouse?
Rich

 

[Ross]

It sucks when Medicare won't cover something that your paying premiums for in the grand scheme of things. My problem is, I cannot afford to take on any other bills. I'm all tapped out, nearly bankrupt and now facing what may well be the final financial conflict for us.

 

[skeptic49]

Sorry to read about the financial problems, Ross. You would think that in such a wealthy country as ours, no one would be driven to the point of insolvency over medical bills. Unfortunately, that's not the case.

Jim

 

[dick0236]

Rich, I pay $54/mo to cover me and my wife. Remember though, I live in Kentucky. We are not as high a cost area as you would be in the North. Premiums are determined by the dental costs in that market. I'm not sure as to the name of my plan, but it would be considered a PPO. I'm sure that it is not nearly as good as what you have thru GM, but it is adequate, especially if a lot of major procedures are not necessary. My primary reason for having it is to pay for annual cleanings and to make sure that my dentist receives ONLY a fair price for his service. If it were not for Delta Dental, I would have no choice but to accept his charges, fair or not.

As Ross pointed out above, this is one more piece of an enormous social and fiscal problem that nobody really knows how to solve.

 

[Ross]

Sorry to read about the financial problems, Ross. You would think that in such a wealthy country as ours, no one would be driven to the point of insolvency over medical bills. Unfortunately, that's not the case.

Jim

Thanks Jim. Fact is, I barely got off the ground and had only a few work year credits to my name when my health went down the tubes. I was effectively disabled after my aneurysm ruptured in 95 at the rip old age of 33. Since then, between my other surgeries and the wifes, medical bills have all but killed us. With my wifes, it was an emergency kidney surgery with no insurance because she was laid off at the time. We've just had crappy luck ever since.

 

[Rich]

Thanks Dick we will look into that. Currently we have the PPO.

Ross I'm sorry as well to hear this news, a guy like you and your family sure deserve a hell of a lot better.

Rich