Delta Dental - not really insurance

[aperture]

Passing along a learning FYI

After a routine x-ray, our dentist suggested that my daughter have a simple tooth extraction x 2 due to adult teeth getting turned by baby canine teeth.  We have Delta Dental and were seeing a participating dentist (in PPO network).  The estimated cost from Delta Dental was $81 for each procedure = $162 and patient responsibility was $24.30 x2 = $48.60.

On the day of the procedure, the dentist asked for payment of our part of the procedure which seemed reasonable - but they charged $145 per tooth and asked for  $176.60 total as our part.  When we got the notice of benefit payment from Delta Dental it had all the same numbers: dentist charged $145 x 2, the approved amount for the procedure was $81 x 2 and patient responsibility is $24.30  x 2 = $48.60.  So I looked at the DD website and discovered this language:

"All in network cost estimates are based on aggregated data and do not reflect the specific amounts that may be charged by a particular dentist."

I investigated further and discovered that I pay $17.50 per 2 week pay period and that there is a $1,500 maximum benefit per year for each member of my family.

So I pay $17.50 every 2 week pay period for a sort of insurance that covers me and the family for 50% to 100% (depending on the procedure) of 55% of the cost of dental procedures (30 to 50% of total cost) up to a maximum of $1500 per year.  We maxed out one account in 2015.  So even with the very confusing benefits, we ended up spending <$500 in 2015 for >$1500 of benefits. 

Now if we were not "covered", would we have shopped more carefully for price?  Probably yes and we probably could have done better.   Now we have already opted in for 2016, so we will have to work on finding best deals with the Delta Dental benefit this year. 

Please share any experiences or links to similar threads - search function on MMM forum seems to not work at the moment.  Thanks, Ap.

[TheDude]

Sounds like you got screwed. Delta and your dentist should have an agreed upon price. You shouldn't trust delta though. The dentist should provide the charge upfront.

Also are you sure it was in network and not a premiere dentist?

[zinethstache]

Here's now my insurance works. They will pay x% of the MINIMAL quality of work being done.

I.e. for my crown I need redone, I will get 50% of a porcelain covered gold crown. that is $720, so my portion is half that.

My dentist is very transparent and my bid showed all 4 crown type options, going all the way up to $1250 same day 3d printed in their office crown. I of course being mustachian opted for the least expensive, there is NO difference in how the crown will wear between the 4 options, the two most expensive are one office visit, the two cheaper require 2 visits.

I have the same $1500 max you do. My cleaning is covered 100% BUT only for basic xrays, my dentist did alot of extra stuff that was not covered, however, they did NOT charge me for it.

I do feel it is your dentist's responsibility to be very transparent with charges and what you have to pay, this does often vary from what the insurance's minimal coverage includes. I think you are fine with your insurance (sounds standard to me) you need to look for a more helpful dentist.

ah, and another quick story of how honest our dentist is. I was just asked where to apply my husband's credit, because the insurance paid more and they did not just keep it, they applied the extra to us for our out of pocket portion we paid.

Eye insurance is the same, seems like it is not really insurance at all.

[aperture]

Thanks for the input.  I do think I need to do a better job of discussing costs with the dentist.  I had ass-umed that since he was in network that the price quote on Delta Dental website was what the price would be.  My mistake.  When we have to put braces on the soon to-be-teen child, we will get several price quotes and research more carefully.

Zinethstache, thanks for the explanation.  If I go back to the dentist, he will probably explain that he uses special techniques that work best, are more expensive and therefore charges more.  Because he is in a wealthy suburb, he does not discuss (or offer) lower cost options.  As I say - it is a buyer beware world, and I failed to understand, but won't make the same mistake twice.

Thnaks, Ap

[Helvegen]

Dental insurance should really be called a dental discount network. The value is ultimately in the discounted pricing you get from participating network providers, not in the yearly benefit max.

Dental and vision make up 90% of my expenditures out of my HSA.

[fa]

You are correct.  There is no such thing as dental insurance.  There are a variety of prepaid discount dental plans.  Delta Dental is one of those.  The name "insurance" sounds better and is used to sell the product.  BTW, unlike prepaid discount dentistry, medical insurance truly is insurance.

If you have an option to receive the employer premiums rather than getting the discount dental plan, take the premiums and put them in your HSA account.  You get to keep that money for yourself.  If you are paying the premiums out of pocket, stop today.  You are wasting your money.

[MrFrugalChicago]

Yah so I spent a year self employed. Looked into it, and dental insurance wouldn't really do me any good.

Now that I am back at a 9-5.. it "works" because my employer pays 75% of my policy, I pay 25%... so a cool way to save some cash on dental.. but overall yah it is a rip.

(Health insurance is a rip in a different way.. it CAN cover a $1 million dollar cancer treatment, which I can't self insure on. Nothing my dental insurance will do will cover me like that (and in fact it caps out at a few thousand dollars).

[catccc]

I have delta dental, and whenever I use an in network provider, my out of pocket costs are minimal (20% co-insurance for basic services, 100% covered cleanings), and there is no balance billing (what you just described, basically owing 100% of the difference between delta's rate and the provider's rate.)  I would call delta and ask about it.  I have used two in network providers for my family (kids, and specialty work for me) and out of pocket costs have been nominal.  I personally strongly prefer my out of network dentist for my general dentistry needs and paying the balance billing is worthwhile for me to get to see the dentist I trust.  (I also trust my kids' dentist, but it's a pediatric practice.)  My teeth are also a mess, so I get to partake in the 50% co-insurance for major services.

Also, my employer only makes me chip in $23/month for it.  Our benefits exceed what we pay in premiums, so I'm okay with it all.

[digitaldetachment]

You are correct.  There is no such thing as dental insurance.  There are a variety of prepaid discount dental plans.  Delta Dental is one of those.  The name "insurance" sounds better and is used to sell the product.  BTW, unlike prepaid discount dentistry, medical insurance truly is insurance.

If you have an option to receive the employer premiums rather than getting the discount dental plan, take the premiums and put them in your HSA account.  You get to keep that money for yourself.  If you are paying the premiums out of pocket, stop today.  You are wasting your money.

Hi all. New here, but I'm with FA.  One of my first Mustachian cost-cutting gambits was to drop the Delta premiums I'd opted into many years ago.  The premiums were nearly $500 per year for $1500 max benefit. Insane.  For two teeth cleanings per year, I'll pay about $230 direct to dentist.  So that's about $270 "employees" per year (less in x-ray years) working for me instead of delta.   

If anything major comes up, that's what the HSA / health insurance is for.

[FIRE me]

You are correct.  There is no such thing as dental insurance.  There are a variety of prepaid discount dental plans.  Delta Dental is one of those.  The name "insurance" sounds better and is used to sell the product.  BTW, unlike prepaid discount dentistry, medical insurance truly is insurance.

If you have an option to receive the employer premiums rather than getting the discount dental plan, take the premiums and put them in your HSA account.  You get to keep that money for yourself.  If you are paying the premiums out of pocket, stop today.  You are wasting your money.

I have Delta Dental and it pays dentists on my behalf. I pay 0% to 20% for the large majority of procedures at participating dentists, although some procedures (such as implants) are are only covered at 50%.

Like all health insurance, they do bargain down the retail price charged by the health care provider.

My premium is $208 annual, and it is a rare year that I don't get that back in benefits paid.

[electriceagle]

You're right. Dental insurance isn't really insurance.

Dental insurance only "works" when
1) It is paid (in part or in full) by your employer,
2) Your premium is tax deductible
or 3) There is information asymmetry (you know that you need to have dental work done)

Otherwise, you might as well pay out of pocket.

[Tom Bri]

One of the jobs I do for the insurance company I work for is to review dental insurance claims. Not Delta, but very similar type plans.
If your dentist is in network, he should be able to tell you exactly how much you will pay. He can call the network and get a copy of his contracted fee schedule, read the code and see exactly what the network allows.
Unfortunately, many dentists (and their staff) have no idea what networks he may have signed up with, so you call and he says in all honesty, yes he is in network, but after all is done, it turns out he isn't. Then, you end up with the patient paying the difference between what insurance pays and whatever the dentist charged.
If you are only getting routine checkups/cleanings each year, you will probably lose money buying dental insurance. Most people lose money (obviously).

[aperture]

Thanks Tom Bri - very helpful information. -Ap

[Pigeon]

We also have Delta Dental.  I have it through my union, dh has it through his employer.  Note that each employer may have different levels of coverage through Delta.  My plan pays more for some procedures than dh's, but his pays more for other procedures.

In the example you cited, in my case, we would have been on the hook for whatever percentage wasn't covered by Delta, but only up to the agreed upon payment for the specific procedure if the dentist was in-plan.  I would verify with Delta that the dentist is in-plan and that you are on the hook for that much.