How do you find a decent dentist that will accept your insurance as full pymt?

4 Comments

1. RNcalledEd says:

   September 10, 2009 at 11:51 am

   To add to HeatherS above… Many dentist sign agreements with insurance companies which limit your out-of-pocket expenses. They may pay 50% or 80% of the cost of a procedure, but it will be 50% or 80% of a predetermined amount, and not what the dentist charges… you pay your share of what the insurance company allows, and the dentist writes off the difference…

   Example: The dentist charges $150 for a certain filling and you have 80% coverage. The insurance company allows only $100 for that filling. They will pay 80% of $100, and you pay 20%, or $20 of the $100… the extra $50 the dentist wants to charge is written off…

   To find a dentist who has made such an agreement, try calling your dental insurance… they may have a list they can send you. You can also call a dentist and ask if they are a PARTICIPATING PROVIDER with your insurance. USE THAT TERM, since most dentists will say they accept your insurance, but if they don’t PARTICIPATE, they can charge that extra $50 I mentioned above to you…

   Be careful you don’t go over the benefit maximum for your year… if you do, you make up ALL the difference… contact your insurance company’s Benefits depaartment to clarify what is and isn’t covered and what the % of coverage is.
   Best,
   Ed, RN
2. bmac says:

   September 10, 2009 at 11:51 am

   Sorry. The only thing they will pay in full is cleanings–no more than twice a year. No dental insurance will pay for that kind of dental work. I’ve been there. 2 root canals, 2 crowns, 2 extractions then 2 implants. I had to pay for everything except for half of the extractions. That’s it.
3. HeatherS says:

   September 10, 2009 at 11:51 am

   bmac is correct. You should read your policy coverage, there is a cap on how much your allowed each year and what percent of which services they cover. Most all policies have cleanings twice a year with a copay or deductible, it’s the other things like root canals and crowns that start adding up and just use up the annual limit fast. Some even have a pre-existing clause or a wait period. Most policies have a cap of $1000.00 or $1500.00 per year. So you really can’t get a lot of work done in one year along with the necessary cleanings. Sorry I couldn’t give you any better information, but that’s just how it works. Hope I’ve been of some help and good luck with your upcoming procedures.

   Additional information: RN is correct, call and ask if they are a participating provider prior to having any work done with them or you may find you have a huge outstanding balance. There are some insurance co. that pay 80-100% on root canal procedures and usually about 50% for crowns and build ups. It’s just a matter of what percent your insurance provider is willing to pay and if your dentist is a provider or has an agreement with the insurance company. Keep an eye on the cap for the year so you don’t go over having to pay the full payment the dentist charges. Some work that isn’t immediately needed can be put off until next year. Dentist are aware of this and are willing to work with you. Don’t be afraid or ashamed to ask about your insurance coverage. The office manager or insurance clerk (which is who you will need to discuss arrangements and insurance with, not the dentist) will go over your treatment plan, schedule the necessary appointments based on immediate need, along with insurance coverage, you’re out of pocket expense and what you can afford for the procedure and the year. You aren’t the only one in this situation; the majority of patients are concerned with the same things. Be thankful you have the coverage although it may seem small, so many don’t have any and their dental health suffers greatly due to the expense involved. In these cases, it’s the small problems left unchecked until they become a larger problem requiring extensive work with added expense. In most of these cases the patient can’t afford procedures and opts for extraction, loosing an important tooth in their dentition. Then problems develop due to its loss, just creating a snow ball effect. So, any time you have a small problem, get it checked early. The smaller the problem the less the expense, is what I always tell patients.
4. Stacey217 says:

   September 10, 2009 at 11:51 am

   Unfortunately, the percentage of payment is determined by your insurance company, not the dentist. So sure, you could find a less-expensive dentist, but the insurance company would still only pay the same percentage of the fees. So, for example, if your plan covers 70% of procedure X, then they will pay 70% whether it costs $100 at one place or $200 at a different place. Of course, insurance plans often use "negotiated" fees, so they generally end up paying the same amount anyway regardless of the actual charged fee.

   I have never seen a dental plan that paid for 100% of anything but the intial visit and then regular cleanings every 6 months. I would imagine that such plans do not exist.

   My suggestion is to work with a dentist that will help you with the financing of the dental work. They are out there. Dentists know that their services can be quite expensive and are generally not covered completely by insurance, so many are willing to work out a payment plan.