Dentists and Dental Insurance

[chemistk]

A brief background: we (wife and I) have dental insurance (PPO, United Concordia) through work and only pay $12/month pretax for the plan. It's a pretty typical plan ($2000max, most services in network are covered, etc.).

It has been a few years since my wife saw a dentist and she needed to go. We didn't have a regular dentist, but one of her friends' dad has a practice half a mile from our house. Before going we confirmed they accepted our insurance, we're happy with his fee schedule (maybe 5% higher than average for the area), and this practice is one of the most positively talked about practices in the area, so we thought it was a no brainer, slam dunk. She ended up having an initial cleaning and then came back a week later to have a few cavities filled (she knew they were there). All is good, right?

For whatever reason, the insurance and payment process has been screwy. The cleaning and initial exam were billed as in network services, and we paid up front for the difference of what insurance was not going to cover. The fillings were viewed as out of network services by our insurance and they paid out the minimum to us for them, leaving us to make up the difference. Somehow, after talking to our insurance, the dentist is no longer considered an in network provider by them. So, I went onto the insurance website and looked up current in network providers, and the only one within 10 miles of us is one of those huge dentist offices that has a staff of dentists. Plus, there are some not-so-nice complaints about the dentists there as well as the practice as a whole. Of course.


So here's my dilemma: I have an appointment scheduled with the "good dentist" next week. I know I'll be needing restorative work on one tooth in the next year or two and it'll be pricey. I am hesitant to visit the "dental group" but if they're going to cost much less to go to, I might just have to suck it up. I've grown up going to a local, one dentist operation who did fantastic work over the years, but that's 3 states away now. Think I should cancel my appointment for the sake of costs, or should I stick with the "good dentist"?

I'm also open to alternative suggestions. I gave myself a crash course in dental insurance and Dental billing last night so there may be some things I'm missing.

[AmandaS1989]

Here's how I would consider it.

1. Would paying for this visit put you in a bind financially?
2. Are you comfortable with this dentist and does he do good work?

That's basically what I look at. If you go with cheapo dentist and they do shoddy work that isn't worth your money or worse, needs to be fixed by another dentist, then that's not going to save you any money in the long run. I'd rather pay a little more for a good quality dentist that does good work than go with a not-so good dentist just to save money. If people are already complaining about their work then I wouldn't go. I would stick with the good dentist.

In my own experience I had my wisdom teeth surgically removed back on May 27th. It was $1876. My friend paid only $1200 and thought she was getting quite the bargain. But I had a surgeon who took good care of me and made sure I had prescriptions for antibiotics along with anti-nausea, pain meds, and anti-inflammatory. My friend was told by her surgeon to ice it down and take ibuprofen when she started swelling really bad. Yesterday she went back to him because she developed a lump in her cheek. It was caused by a mild infection. He finally wrote her an antibiotic prescription. Sometimes you get what you pay for.

[Stash Engineer]

We just recently went through the same experience.  In short:  Unless you simply can't afford it, go to the good dentist. 

Long(er) version:
My wife had a crown that broke.  We decided to go to the in-network dentist rather than the nicer, more expensive, out-of-network dentist a friend recommended.  The dentist office is in a strip mall.  Once the crown arrived 2 weeks after ordering it, the dentist broke it trying to put it in.  Funny part was that he was bragging the whole time about how nice the new crown was and how strong the material is.  So he did a temporary repair and ordered a new, supposedly stronger crown that took 4 weeks to arrive.  She just had that one put in 2 days ago.  I'm worried it won't hold up long. 

2nd round:  My 6 year old needed 2 crowns (yeah I know).  We were once again recommended a dentist that wasn't in our network.  Just to see, we asked the receptionist at the above in-network dentist office if she knew anything about the in-network pediatric dentist.  Thankfully she was honest and said don't go there.  We ended up paying a lot more for the out-of-network dentist, but were 100% happy with the service and results. 

[catccc]

Can you find out what insurances the good dentist is in-network with?

I have coverage at work for $23/month for my family of 4.  My two kids go to an in-network pediatric dentist.  DH and I go to a trusted out-of-network dentist.  My teeth need a lot of work.  The balance billing gets to be kinda high.

So I got a list of insurance companies that are in-network for my dentist, and got to researching.  Turns out Cigna sells an individual plan for $34/month.  This is kind of a lot for one person, but it turns out I can carry both insurances- individually paid is primary, and my  group employer insurance is secondary.  I had 2 cavities filled last month, and I calculated my savings (after the premium and the new deductible, even) at about $100.  It might be even more if my secondary coverage pays anything out, which they may, I'm not quite sure yet.  I'm having even more significant work done next month, so there will be even more savings.  I do plan on dropping the individual coverage once my work is done, and I will pick it back up again if needed.  Cigna might not like that, but I don't believe I'm breaking any rules.  There were a lot of components to understand in lining this all up- which was primary, waiving waiting periods, etc.  But it seems to have panned out in my favor.

If this didn't work, I was going to try an out of network dentist.  I have heard good things about the other practice I was considering.  So it's possible that I would have ended up at an in-network dentist I was just as happy with.  But this works, too.

[SimplyMarvie]

If you need major work, have you considered going abroad as an alternative?

I never, ever thought I would suggest this and have bought into the US Dental folk's way of looking down on non-US dental work. Then, in the same year I had two teeth directly across from each other break on me (I have lousy teeth and always have had... genetics were not my friend when it comes to anything dental). The first I had crowned in Northern Virginia. It took two weeks to get in with a dentist in-network for my insurance. I need gas, because I'm a coward, but otherwise it was a straight forward crown. The initial cost was $1800, written down by my dental insurance and split 60/40, I paid a bit under $600 and it was three visits until it was settled in my mouth, with lots of drama and angst.

Two months later, I had a tooth break here in Eastern Europe. I was in the next day, they filed down the tooth, 3D printed the crown from zirconium in the office, and attached it to my tooth. It took 3 hours, and with the gas I paid $75. Feeling them in my mouth, the US tooth feels large and unwieldily and fake in my mouth. It also butts up against the tooth in back of it which will probably cause additional problems down the line. The tooth I got done locally is almost indistinguishable from my other teeth, fits in my mouth perfectly and has never caused me a moments distress since I got it.

Long story short, I am now utterly converted to dental tourism.