delta dental insurance fuckery

[frugalnacho]

I've been going to the same dentist office for about 7 years now and never had an issue.  I've always had delta dental insurance.  I started a new job at the end of 2018 and they also provide delta dental insurance.  I double checked the delta dental website to see if they are a participating ppo (even though I previously had delta) and 26 results come up for my area (for all locations of this particular dental office), 3 of which are the office I use, so I figure I'm good to go.  I call my dentist office and give them my new insurance information prior to my scheduled cleaning.   

I go in for my cleaning, and get hit with a $50 deductible for a cleaning.  I think surely this is a mistake, someone at the front desk reentered my new insurance and is misreading the part about a $50 deductible, and it's going to get sorted out when they send the bill to insurance and I'll get my $50 back - wouldn't be the first time something like this has happened to me (though usually for dr not dentist).   I ask for an explanation, but they can't give me one other than I have a deductible that must be met - sounds like they don't know what they are talking about.  I'm not going to cancel my appointment and pay a cancellation fee to avoid something that I'm pretty sure is a mistake.  Also, they didn't mention the $50 deductible until I was in the office for the cleaning, even though I called in advance and gave them all my new insurance information to ensure there were no hiccups.  When I get my EOB in the mail, and sure enough the $50 deductible is legit.

Turns out delta dental has multiple tiers of services.  Dentists can be "PPO" or they can be "premiere".  Basically PPO is in network - deductible doesn't apply to preventative, coinsurance is 10%, and there is a maximum amount the office can charge.  Apparently a premiere office is basically out of network - deductible must be met for all services including preventative, coinsurance is 20%, and while there is a maximum fee the office can charge it is different from the maximum that a premiere office can charge with the balance being the patient's responsibility.  They claim you can see any dentist of your choice, you aren't restricted to a PPO dentist because you can see a premiere for just a little extra charge.  It's a bit deceptive (IMO) the way it's presented as 10% vs 20% coinsurance.  For example, I have a cavity that needs to be taken care of.  The max PPO charge is $110, the max for premiere is $145.  If I see a PPO office the price is $110, 10% of which is my responsibility so $11.  If I see a premiere dentist the price is $145, and I owe 20% of the $110 plus the difference, so $22 + $35 = $57.  I actually have 2 small cavities, so the differences is really $22 vs $114.

I'm confused as fuck because I've been going to this office for 7 years and had delta the whole time and never dealt with this nonsense.  When I press the office for more information that is when I am told they are a premiere office, and that's when I do research and discover about the tiers of service in the above paragraph.  Still thinking this is a mistake (because delta dental's website lists multiple dentists at that location as PPO, and I've been getting charged as a PPO the entire time prior to this) I contact my HR rep, who in turn contacts delta dental, to get to the bottom of it.  I am told that some dentists are PPO, and some are premiere, even at the same office and that I should instruct the office that I want them to resubmit my insurance claim under PPO and clarify that I only want to see a ppo dentist from now on. 

When I called the office to ask this they informed me that they are a premiere office - the office itself is premiere.  They do have 1 ppo dentist (despite delta naming multiple on their website), but that the office itself, and all the hygienist are premiere so cleanings and all other services will be billed as premiere even if I see a ppo dentist. 

None of this makes any fucking sense! I'm now searching for a new dentist, but I don't even know how to proceed since the information on delta dental's website is apparently wrong.  Do I need to randomly call local dentist offices and ask if they are a delta dental PPO office, and also if their dentists and their hygienists are participating ppo members as well?   Plus I'm in a bit of a jam as I just used 1 of my 2 cleanings/preventatives for the year, but also have 2 small cavities that need to get filled.  If I stick with this office I am going to be charged an extra hundred dollars over a ppo office.  Although I imagine if I swap to a new dentist they are going to require me to at the very least have an exam performed before they start doing dental work (even though I just had an exam less than a month ago and won't be eligible for another after that until 2020).

[BicycleB]

THAT sounds like a freaking mess.

[Dollar Slice]

Ugh, that is so frustrating. I had a similar experience with Aetna medical insurance - I found a doctor through their website (to make sure they were in network), and then was billed $700 because it turned out the doctor was "in network" but not in the PREFERRED network (similar to your PPO/premiere, except that instead of coinsurance I was on the hook for the entire thing). It's so scammy, and I'm sure they do it on purpose since successfully confusing the customer means the customer pays more and the insurance co pays less.

My solution was to call them on the phone and have them verbally confirm every time I saw a new doctor that the doctor would be covered in their preferred network. If you're gonna have a purposely confusing website, I'll be using a lot of your company's resources to answer the phone.

[ixtap]

Delta Dental itself has various tiers, but only if the dentists are in the right tier. If there is a tier mismatch, then it all becomes wonky, as far as I can tell. I have a PhD, have successfully worked a number of jobs that require government paperwork and I am still a little confused.

We found this out when DH got bumped up to "executive" benefits with his last promotion a few months ago. He still doesn't have anybody reporting to him, so I am wondering if successful navigation of the new benefits is a prerequisite for the next promotion.

[tipster350]

You have to read your insurance information very carefully. Your dentist may have been in network in your old employer's plan and in the second tier in your new employer's plan. It's not Delta per se, it is insurance plan differences between employers.

[wageslave23]

I hope you don't have to pay monthly premiums for the dog shit that is dental insurance. 

[frugalnacho]

If you go to Delta's website it doesn't ask what your insurance policy is, it has a list of dentists and classifies them as PPO or premiere.  I've consulted the website, and contacted a Delta rep about it, and I'm still not clear on whether a dentist is in my network or not. 

[AnonymousCoward]

Delta decided that someone on the opposite side of the country, who I've never heard of, who is six years older than me, is my dependent child. And that their elective procedures were my responsibility. It took about four months to straighten that out.

How much does your employer contribute towards your premiums? How much does your dentist charge if you pay in cash? How healthy are your teeth? It might be reasonable to cancel your insurance next year and just pay directly.

[Pigeon]

You have to read your insurance information very carefully. Your dentist may have been in network in your old employer's plan and in the second tier in your new employer's plan. It's not Delta per se, it is insurance plan differences between employers.

This is true of Delta and is true of most insurance providers.  Delta is a company.  They provide various insurance plans.  Your employer contracts with Delta for a particular set of coverage for their employees.  You need to know what your specific plan covers.

I have Delta through my employer.  Dh has it through his.  The plans vary in terms of what is covered and for how much.

[frugalnacho]

You have to read your insurance information very carefully. Your dentist may have been in network in your old employer's plan and in the second tier in your new employer's plan. It's not Delta per se, it is insurance plan differences between employers.

This is true of Delta and is true of most insurance providers.  Delta is a company.  They provide various insurance plans.  Your employer contracts with Delta for a particular set of coverage for their employees.  You need to know what your specific plan covers.

I have Delta through my employer.  Dh has it through his.  The plans vary in terms of what is covered and for how much.

In my experience it is only the details that change though.  If the dentist office is a PPO of delta, then they are a ppo to everyone with a delta plan even though your specific plan details (deductible, coinsurance, and some specific services) will vary from plan to plan.  Somehow they were PPO for my various delta plans for the last 7 years, but now they are no longer a PPO and are instead premiere.  Same with health insurance, if you have cigna or BCBS or whatever, you can find out which doctors/hospitals are in network and which are out of network, and the specific charges you incur will be according to your specific plan (but will be calculated based on in/out of network status).

It's absolute insanity that an office/dentist/doctor can be in network/ppo for one plan, and out of network/premiere for the same exact insurance company, especially when that insurance company doesn't have any way to differentiate them.  If you go to delta's website and search for a dentist they don't ask what type of plan you have, they only ask what classification of dentist you want (PPO or premiere). 

EDIT: It could be that my dentist's office changed status from PPO to premiere for 2019 also...but they haven't stated that even though I've asked.  It's difficult getting a direct answer from them.  When I check t he delta website they only list individual dentists and classify them as either PPO or premiere or both.  They don't list hygienist, and they don't list offices as a whole.  According to delta each individual dentist has their own contract with delta, and multiple dentists can work at the same office and have different contracts.  Also according to delta the billing should be classified by which dentist you see though.  It was news to me that the hygienist and office itself can be classified differently from the dentist.  I am still waiting to hear back from delta on how that makes sense, and if true, how the fuck am I supposed to find an in network office.

[FireAnt]

I have Delta Dental myself and decided to check and see what mine is classified as... what do you know, I've been going to a "Premier" dentist instead of a PPO this entire time. Time to find a new dentist...

[radram]

I agree its all fucked up.

Also, what about the "here it the estimate, and if we are wrong and your insurance pays $0, you owe it ALL and agree to pay it..... now sign for today's work or pound sand?"

And why do I have health insurance that does not cover my teeth, my ears, or even my EYES for fuck sake.

[frugalnacho]

I agree its all fucked up.

Also, what about the "here it the estimate, and if we are wrong and your insurance pays $0, you owe it ALL and agree to pay it..... now sign for today's work or pound sand?"

And why do I have health insurance that does not cover my teeth, my ears, or even my EYES for fuck sake.

Yes I've been through that rigmarole with them too, except they were very unsure of the price.  It was more like "here is the price...we think... but that may change and your insurance may not pay anything".  So of course I responded to have them actually check up on it.  Went round and round with them unable to give an answer, and eventually called the insurance company myself and their response was basically "lol we don't know.  You'll have to submit to claim after the services are rendered to see what the magic box spits out".  It was incredibly frustrating.  I tried talking some sense into them saying there is absolutely no discretion involved in this process, it is completely deterministic.  You have set prices for every procedure according to code, so just put those fucking codes in and tell me what you'll pay! Just pretend that I already had the procedure, and put those codes into your system.  I never did get an answer and my wife just had the work done anyway because what are you gonna do? Not get necessary dental work done because they refuse to nail down a price?

[BicycleB]

I agree its all fucked up.

Also, what about the "here it the estimate, and if we are wrong and your insurance pays $0, you owe it ALL and agree to pay it..... now sign for today's work or pound sand?"

And why do I have health insurance that does not cover my teeth, my ears, or even my EYES for fuck sake.

Yes I've been through that rigmarole with them too, except they were very unsure of the price.  It was more like "here is the price...we think... but that may change and your insurance may not pay anything".  So of course I responded to have them actually check up on it.  Went round and round with them unable to give an answer, and eventually called the insurance company myself and their response was basically "lol we don't know.  You'll have to submit to claim after the services are rendered to see what the magic box spits out".  It was incredibly frustrating.  I tried talking some sense into them saying there is absolutely no discretion involved in this process, it is completely deterministic.  You have set prices for every procedure according to code, so just put those fucking codes in and tell me what you'll pay! Just pretend that I already had the procedure, and put those codes into your system.  I never did get an answer and my wife just had the work done anyway because what are you gonna do? Not get necessary dental work done because they refuse to nail down a price?

Million percent agree!

I generally oppose complicated laws, thinking they cause unexpected problems. But there's so many problems in our bizarre current system. I feel like a law that says they must give a quote and can't charge you more than the quote would be really nice.

[Seadog]

Jesus... what a nightmare. Fortunately, I've only ever had to deal with insurance for minor things, and never had huge problems, but it's things like this why as a rule I generally get the absolute minimum insurance possible. MMM's article on it outlined my stance perfectly.

My Grandmother however, even after getting an all clear from a doctor, had a $34k air ambulance bill refused because of a 'pre-existing condition' clause.

They literally said "Multiple doctors in both the US and Canada said it wasn't, but we say it is, so fuck off we're not paying it" Then we had to get lawyers and doctors involved, and eventually got it paid, but it was tremendous hassle and expense to deal with, while simultaneously trying to wrap up her estate.

Public systems are far from perfect, but you can generally leave knowing what you'll pay (generally zero). Insurance companies, be them health in the US, home or car here, or any other are all cut from the same cloth. Just like the airlines. "Pay us money today. You have this huge list of obligations. We'll deliver our end of the bargain when you need it; maybe, and if we don't, you have zero recourse short of a fight that is in our interest to make wholly more hassle than it's worth"

Fuck that noise. Get to the point where you can absorb a 5 figure loss effortlessly, and then *knock on wood*, hopefully you'll never need insurance, because it only gets called on for true big scale emergencies, and you're saving lots of money because it's only called upon for 'holy shit' times.

The nice side effect is that by acting as your own insurance company for small things (say <25k), you will at least in theory come out ahead over the long run. It would be an interesting study to see a histogram/distribution of how many people come out ahead after a life time of insurance in all types.

[I'm a red panda]

I agree its all fucked up.

Also, what about the "here it the estimate, and if we are wrong and your insurance pays $0, you owe it ALL and agree to pay it..... now sign for today's work or pound sand?"

And why do I have health insurance that does not cover my teeth, my ears, or even my EYES for fuck sake.

Your health insurance doesn't cover your ears?
Mine also covers my eyes, if the eyes are a medical issue. My corneal ulcer was billed to medical, even though I saw an optometrist. Glasses are not, unless you are legally blind.


As for Delta Dental- I apparently have premier and my insurance is PPO. I didn't find this out for 7 years. The only thing that has been an issue is the max payment is $500 less to go to them. If I had known this, I would have gone elsewhere, as I always hit my max, and $500 a year is a lot.  But I receive more service than I pay in premiums.

[radram]

I agree its all fucked up.

Also, what about the "here it the estimate, and if we are wrong and your insurance pays $0, you owe it ALL and agree to pay it..... now sign for today's work or pound sand?"

And why do I have health insurance that does not cover my teeth, my ears, or even my EYES for fuck sake.

Your health insurance doesn't cover your ears?
Mine also covers my eyes, if the eyes are a medical issue. My corneal ulcer was billed to medical, even though I saw an optometrist. Glasses are not, unless you are legally blind.


As for Delta Dental- I apparently have premier and my insurance is PPO. I didn't find this out for 7 years. The only thing that has been an issue is the max payment is $500 less to go to them. If I had known this, I would have gone elsewhere, as I always hit my max, and $500 a year is a lot.  But I receive more service than I pay in premiums.

Your health insurance doesn't cover your ears? If you mean once they no longer serve the purpose they were intended, then no it does not.Hearing aids are not covered.

Consider a knee. If it runs through its useful life, I can get a new one under insurance. It does not matter if I fucked it up because I did something stupid, or it just wore out. Why can I get a new knee, but not a device that makes the ear hear again. It is just so arbitrary.


Mine also covers my eyes, if the eyes are a medical issue. My corneal ulcer was billed to medical, even though I saw an optometrist. Glasses are not, unless you are legally blind. This is even more to my point of the arbitrary nature of all this. Why is the ulcer medically necessary to avoid going blind, but the glasses are not(I am blind without them). Hell, they are even required for me to legally drive. How the fuck is that not a medical necessity?

[DaMa]

You have several issues going on here.

1.  Your employer chooses your health plan.  The insurance company constantly changes those plans to meet the demands of the employers by lowering benefits, adding copays and coinsurance, prior authorization requirements, and narrower networks. Anything and everything can change every year.  Read your open enrollment materials carefully.  Do not expect your doctors to keep up with your benefits.

2.  Insurance companies are constantly adding and changing contracts with providers.  They DO NOT keep their websites or printed materials up to date.  (For some plans there are government mandated requirements around how frequently these need to be updated, like Medicare Advantage plans, but generally no requirements for employer plans.)  You're best bet is to call your insurance plan and confirm by phone, because they will be looking at their current database of information. Always note the date, time, and who you talked to so you can reference the call if needed.  Those calls are recorded, and you can hold them to what they say via the appeals and grievance process even if they make a mistake.

3.  If your provider belongs to some sort of group, they likely don't know any better than you do who is in what network, because the contracts are handled by the group adminstrator.  They are calling the same people at the insurance company that you are calling.  You can't hold the office staff to anything they say.

4.  All of the people you talk to -- the clerk at the dentist office, the customer service rep at the insurance company, the billing staff (ESPECIALLY the billing staff) -- probably have met minimal education requirements, get paid minimum wage or not much more, and have no idea how to do the math required to calculate your out-of-pocket.

Your experience is why narrow networks (PPO vs Premiere) cost employers less.  There are always people who will pay more not to change doctors or not realize what's happening until they already are paying more.

It's amazing how businesses get away with so many unfair practices in the health arena.

[Fields of Gold]

used 1 of my 2 cleanings/preventatives for the year

How thorough was your cleaning?

My experience with Delta Dental as a subscriber is I didn't get very good cleanings at dental practices, and I sometimes was told no cleaning provided because of great teeth.   Cleanings, when done, were superficially done within five to ten minutes.    Then six months later, the dentist would again say no cleaning needed.  The next month I went to another dentist practice (paying cash) and the hygenist spent an hour removing plaque, especially under the gums.  Instead of premiums, I now pay $40 cash for detailed cleaning each six months (and keep some emergency fund for any future dental issues). 

[I'm a red panda]

used 1 of my 2 cleanings/preventatives for the year

How thorough was your cleaning?

My experience with Delta Dental as a subscriber is I didn't get very good cleanings at dental practices, and I sometimes was told no cleaning provided because of great teeth.   Cleanings, when done, were superficially done within five to ten minutes.    Then six months later, the dentist would again say no cleaning needed.  The next month I went to another dentist practice (paying cash) and the hygenist spent an hour removing plaque, especially under the gums.  Instead of premiums, I now pay $40 cash for detailed cleaning each six months (and keep some emergency fund for any future dental issues).

Where is Delta Dental a provider? Here, it's an insurance company.

[frugalnacho]

Yeah Delta is the insurance company.  My cleanings very thorough.  Overall we are pretty happy with the dental office itself.  I'm just miffed that all of a sudden I have to pay for cleanings and my dental work seems a lot more expensive.  That and the nonsense of the Delta dental website where I can't tell wtf is going on with finding an in network dentist.  If I stick with this dentist I am going to pay $93 more to get my fillings done soon, then my next round of cleanings will be free since I've already met my deductible.  It's a mustachian problem because I'm looking at minimum$100/yr more for me and wife, and more likely$200-300/yr more if we have x-rays and dental work done.  After my fillings we will be approximately $260 out of pocket for 2019 vs I calculate about $67 for a PPO.  I have the money, but I'm already paying for dental insurance so I don't think I should have to pay extra. 

[Fields of Gold]

used 1 of my 2 cleanings/preventatives for the year

How thorough was your cleaning?

My experience with Delta Dental as a subscriber is I didn't get very good cleanings at dental practices, and I sometimes was told no cleaning provided because of great teeth.   Cleanings, when done, were superficially done within five to ten minutes.    Then six months later, the dentist would again say no cleaning needed.  The next month I went to another dentist practice (paying cash) and the hygenist spent an hour removing plaque, especially under the gums.  Instead of premiums, I now pay $40 cash for detailed cleaning each six months (and keep some emergency fund for any future dental issues).

Where is Delta Dental a provider? Here, it's an insurance company.

I had Delta Dental as an insurance provider and used it at local independent dental practices (not a practice named "Delta Dental").

[EricEng]

Premier is a fancy way of saying out of network.  Just find a dentist listed as PPO.

Now if you want really restrictive, try their HMO version.  Depressingly small pool and it is local to your address only, nothing available away from home.

[I'm a red panda]

Premier is a fancy way of saying out of network.  Just find a dentist listed as PPO.

Now if you want really restrictive, try their HMO version.  Depressingly small pool and it is local to your address only, nothing available away from home.

No Premier is a different level of network.

My husband and I both have Delta Dental insurance. I have Premier, he has PPO.  Both Premier and PPO dentists are "in-network" for both of us, but he gets more coverage from PPO dentists, and I get more coverage from Premier dentists.  The coverage totally sucks for out-of-network dentists for both of us.

[rantk81]

Shit... does “premier” also mean out of network for Cigna dentists? My employer changed from Aetna to Cigna for dental benefits this year, and we haven’t yet gone in for a cleaning.... but when I was looking my dentist up last year during open enrollment, I could have sworn there was a tier called “premier”...

[frugalnacho]

Make sure you call the office directly and ask (and be specific because apparently dentists and hygienist within the same office can be different tiers). 

Premier is a fancy way of saying out of network.  Just find a dentist listed as PPO.

Now if you want really restrictive, try their HMO version.  Depressingly small pool and it is local to your address only, nothing available away from home.

No Premier is a different level of network.

My husband and I both have Delta Dental insurance. I have Premier, he has PPO.  Both Premier and PPO dentists are "in-network" for both of us, but he gets more coverage from PPO dentists, and I get more coverage from Premier dentists.  The coverage totally sucks for out-of-network dentists for both of us.

I apparently have both PPO and premiere. My benefits lists prices for PPO, premier, and out of network, and I can choose any dentist I want and pay the quoted prices according to my plan document.  The plan document does not mention the balance billing that I explained in the first post that happens with the premier (pretty sneaky IMO).  I don't know if I've been getting billed under PPO previously, or as premier but with much more favorable terms than I'm getting now.  I know I've never paid the deductible for a cleaning.  I vaguely remember the dentist office explaining something a few years ago about switching contracts or something, and explaining it would cost us a premium over finding a cheaper dentist, but the extra cost was something pretty minimal like $30 so we opted to stay and haven't had any issues until now.   

[SAR]

Ah Delta Dental . . . got my wisdom teeth yanked, and got a bill in the mail for $3000.

The letter said that they were declining to pay for the second 1/2 hour of general anesthetic (that I apparently had).

I laughed at the absurdity of it and ignored the bill, and I never got any follow up. I presume that was their way of telling me to back off on all the expensive dental work.

Great outfit.

It's a good idea to keep in mind to always check the insurance and what you actually do and don't owe. My general strategy is to avoid dentists for 25 years at a time :-)

[EnjoyIt]

It is such a shame that the insurance industry is squeezing its way into dental care.  It was much simpler and less expensive before they arrived.  But such is always the case when we add a bookie in between every transaction.

[elysianfields]

Yeah, THANKS, Obama!! </sarcasm>

Who knew that dental care was so complicated?

[Metalcat]

It is such a shame that the insurance industry is squeezing its way into dental care.  It was much simpler and less expensive before they arrived.  But such is always the case when we add a bookie in between every transaction.

Dental insurance is a new thing??

We have private dental insurance in Canada and we have none of this in-network stuff. Dentists are all "fee-for-service" here, the fee is the fee is the fee regardless of insurance and anyone can see any dentist or hygienist and get the exact same reimbursement amount.

Can someone give me a crash course as to how insurance is "squeezing" into dental care? What did you have before? Is dental part of the ACA? Is that part of why it's so complicated?

[honeybbq]

Delta decided that someone on the opposite side of the country, who I've never heard of, who is six years older than me, is my dependent child. And that their elective procedures were my responsibility. It took about four months to straighten that out.

Holy shit. My brain just exploded.

[I'm a red panda]

It is such a shame that the insurance industry is squeezing its way into dental care.  It was much simpler and less expensive before they arrived.  But such is always the case when we add a bookie in between every transaction.

Dental insurance is a new thing??

We have private dental insurance in Canada and we have none of this in-network stuff. Dentists are all "fee-for-service" here, the fee is the fee is the fee regardless of insurance and anyone can see any dentist or hygienist and get the exact same reimbursement amount.

Can someone give me a crash course as to how insurance is "squeezing" into dental care? What did you have before? Is dental part of the ACA? Is that part of why it's so complicated?

I've had dental insurance for at least 30 years.  It is separate from my health insurance.

I don't know how ACA is involved in dental, as I don't use it. There are children's dental programs from the state for those who qualify for free healthcare for children, I've never heard of it for adults; but all states are different.

[EnjoyIt]

It is such a shame that the insurance industry is squeezing its way into dental care.  It was much simpler and less expensive before they arrived.  But such is always the case when we add a bookie in between every transaction.

Dental insurance is a new thing??

We have private dental insurance in Canada and we have none of this in-network stuff. Dentists are all "fee-for-service" here, the fee is the fee is the fee regardless of insurance and anyone can see any dentist or hygienist and get the exact same reimbursement amount.

Can someone give me a crash course as to how insurance is "squeezing" into dental care? What did you have before? Is dental part of the ACA? Is that part of why it's so complicated?

Why do you need a bookie to skim money off the top of a dental transaction?  Before insurance you went to the dentist, wrote a check and went home.
There is no need to pay a coder and biller to figure out how to bill the procedure, send it in to an insurance company, have someone at the company evaluate the claim and then send money if they deam worth it.  Otherwise the claim is denied and the biller/coder needs to figure out why and send it back again.  Plus the insurance company wants to make a profit taking some money off the top of this transaction.  Why is all that necessary?  Can't I just write a check to the dentist and move on with life?  That is how it has always been years ago.

Dental insurance for adults is a scam as there is no need for insurance.  You buy insurance to insure against a claim that you can't afford.  This does not exist for dental care.  You don't need insurance to clean your teeth or have a cavity filled. It is not like there is some dental emergency that can run up a $100k bill.

[I'm a red panda]

It is such a shame that the insurance industry is squeezing its way into dental care.  It was much simpler and less expensive before they arrived.  But such is always the case when we add a bookie in between every transaction.

Dental insurance is a new thing??

We have private dental insurance in Canada and we have none of this in-network stuff. Dentists are all "fee-for-service" here, the fee is the fee is the fee regardless of insurance and anyone can see any dentist or hygienist and get the exact same reimbursement amount.

Can someone give me a crash course as to how insurance is "squeezing" into dental care? What did you have before? Is dental part of the ACA? Is that part of why it's so complicated?

Why do you need a bookie to skim money off the top of a dental transaction?  Before insurance you went to the dentist, wrote a check and went home.
There is no need to pay a coder and biller to figure out how to bill the procedure, send it in to an insurance company, have someone at the company evaluate the claim and then send money if they deam worth it.  Otherwise the claim is denied and the biller/coder needs to figure out why and send it back again.  Plus the insurance company wants to make a profit taking some money off the top of this transaction.  Why is all that necessary?  Can't I just write a check to the dentist and move on with life?  That is how it has always been years ago.

Dental insurance for adults is a scam as there is no need for insurance.  You buy insurance to insure against a claim that you can't afford.  This does not exist for dental care.  You don't need insurance to clean your teeth or have a cavity filled. It is not like there is some dental emergency that can run up a $100k bill.

I'm unaware what happened before dental insurance, because being only about 40 years old, and being aware of having dental insurance for at least 30 years, I can't tell you how it 'used to be'.

I will say that dental insurance 1) negotiates a lower rate than if I didn't have it, and 2) transfers some of the cost to the company. I pay about $300 in premiums in a year and receive about $2,000 in services.  As for dental emergency that runs up a $100k bill; I know some people for whom that did exist... (basically their entire mouth had to be reconstructed after an accident) and the negotiated rate by the insurance company helped greatly.

[Metalcat]

It is such a shame that the insurance industry is squeezing its way into dental care.  It was much simpler and less expensive before they arrived.  But such is always the case when we add a bookie in between every transaction.

Dental insurance is a new thing??

We have private dental insurance in Canada and we have none of this in-network stuff. Dentists are all "fee-for-service" here, the fee is the fee is the fee regardless of insurance and anyone can see any dentist or hygienist and get the exact same reimbursement amount.

Can someone give me a crash course as to how insurance is "squeezing" into dental care? What did you have before? Is dental part of the ACA? Is that part of why it's so complicated?

Why do you need a bookie to skim money off the top of a dental transaction?  Before insurance you went to the dentist, wrote a check and went home.
There is no need to pay a coder and biller to figure out how to bill the procedure, send it in to an insurance company, have someone at the company evaluate the claim and then send money if they deam worth it.  Otherwise the claim is denied and the biller/coder needs to figure out why and send it back again.  Plus the insurance company wants to make a profit taking some money off the top of this transaction.  Why is all that necessary?  Can't I just write a check to the dentist and move on with life?  That is how it has always been years ago.

Dental insurance for adults is a scam as there is no need for insurance.  You buy insurance to insure against a claim that you can't afford.  This does not exist for dental care.  You don't need insurance to clean your teeth or have a cavity filled. It is not like there is some dental emergency that can run up a $100k bill.

I'm unaware what happened before dental insurance, because being only about 40 years old, and being aware of having dental insurance for at least 30 years, I can't tell you how it 'used to be'.

I will say that dental insurance 1) negotiates a lower rate than if I didn't have it, and 2) transfers some of the cost to the company. I pay about $300 in premiums in a year and receive about $2,000 in services.  As for dental emergency that runs up a $100k bill; I know some people for whom that did exist... (basically their entire mouth had to be reconstructed after an accident) and the negotiated rate by the insurance company helped greatly.

See, we don't have negotiated rates here.

I totally agree with EnjoyIt that dental insurance isn't really necessary, at least not here. It doesn't do all that much for people here, and if they need a lot of work, it's mostly out of pocket. That's why almost no one here has dental insurance unless it's through their employer.

That wasn't what I was asking though, I was asking if there was something different about dental insurance in the US recently. EnjoyIt's statement about insurance "squeezing" into dentistry implies something that is a recent/current process. So I was confused.

Dental insurance has been around here for a very very very long time, so a world where dental was cheaper without it just doesn't exist in our modern cultural memory.

[EnjoyIt]

It is such a shame that the insurance industry is squeezing its way into dental care.  It was much simpler and less expensive before they arrived.  But such is always the case when we add a bookie in between every transaction.

Dental insurance is a new thing??

We have private dental insurance in Canada and we have none of this in-network stuff. Dentists are all "fee-for-service" here, the fee is the fee is the fee regardless of insurance and anyone can see any dentist or hygienist and get the exact same reimbursement amount.

Can someone give me a crash course as to how insurance is "squeezing" into dental care? What did you have before? Is dental part of the ACA? Is that part of why it's so complicated?

Why do you need a bookie to skim money off the top of a dental transaction?  Before insurance you went to the dentist, wrote a check and went home.
There is no need to pay a coder and biller to figure out how to bill the procedure, send it in to an insurance company, have someone at the company evaluate the claim and then send money if they deam worth it.  Otherwise the claim is denied and the biller/coder needs to figure out why and send it back again.  Plus the insurance company wants to make a profit taking some money off the top of this transaction.  Why is all that necessary?  Can't I just write a check to the dentist and move on with life?  That is how it has always been years ago.

Dental insurance for adults is a scam as there is no need for insurance.  You buy insurance to insure against a claim that you can't afford.  This does not exist for dental care.  You don't need insurance to clean your teeth or have a cavity filled. It is not like there is some dental emergency that can run up a $100k bill.

I'm unaware what happened before dental insurance, because being only about 40 years old, and being aware of having dental insurance for at least 30 years, I can't tell you how it 'used to be'.

I will say that dental insurance 1) negotiates a lower rate than if I didn't have it, and 2) transfers some of the cost to the company. I pay about $300 in premiums in a year and receive about $2,000 in services.  As for dental emergency that runs up a $100k bill; I know some people for whom that did exist... (basically their entire mouth had to be reconstructed after an accident) and the negotiated rate by the insurance company helped greatly.

See, we don't have negotiated rates here.

I totally agree with EnjoyIt that dental insurance isn't really necessary, at least not here. It doesn't do all that much for people here, and if they need a lot of work, it's mostly out of pocket. That's why almost no one here has dental insurance unless it's through their employer.

That wasn't what I was asking though, I was asking if there was something different about dental insurance in the US recently. EnjoyIt's statement about insurance "squeezing" into dentistry implies something that is a recent/current process. So I was confused.

Dental insurance has been around here for a very very very long time, so a world where dental was cheaper without it just doesn't exist in our modern cultural memory.

Many dentists in my area do not take insurance. Their practice is full, have less overhead and one dentist I spoke with says he makes more money while charging less for his services (I suspect that is universal but have no way to prove it.)

Taking insurance is great for a starting practice as it helps attract volume. 

Most people don’t buy insurance unless it is offered very cheap by their employer.

@Malkynn, how much do you pay for the insurance and how much does you business pay?  Would you rather get that cash and then go to a dentist that does not take insurance and charges less? As for a dental emergency, it really isn’t a dental emergency if it is trauma which a dentist doesn’t do. You are describing a maxilofacial surgeon for which I believe health insurance would/should take over. Correct me if I am mistaken.

[I'm a red panda]

As for a dental emergency, it really isn’t a dental emergency if it is trauma which a dentist doesn’t do. You are describing a maxilofacial surgeon for which I believe health insurance would/should take over. Correct me if I am mistaken.

The case I'm thinking of was done by a dentist. Basically a full mouth of implants.  This was after reconstructive jaw surgery as well.

I still don't believe dental insurance is a new thing in the US.

[EnjoyIt]

As for a dental emergency, it really isn’t a dental emergency if it is trauma which a dentist doesn’t do. You are describing a maxilofacial surgeon for which I believe health insurance would/should take over. Correct me if I am mistaken.

The case I'm thinking of was done by a dentist. Basically a full mouth of implants.  This was after reconstructive jaw surgery as well.

I still don't believe dental insurance is a new thing in the US.

It’s not new. It’s been around for a long time but moreand more dentists are taking it compared to 10 years ago. I think this is a bad thing.

[frugalnacho]

I pay roughly $242/yr for dental insurance through my employer for my whole family.  Currently only my wife and I use it, as my son is only 16 months old.  Coverage is either employee only, or employee + family.  Seems fairly reasonable to me assuming we get 4 free cleanings per year, and in the event of needing dental work get a substantial discount ($50 deductible, then 10% coinsurance via PPO).  Plus that $242 is all pretax which is nice.

If I stick with my current dentist for the cavity work I need done I'll be up to around $260 for 2019 so far I think.  That's $500 total for dental work, which is going to include 4 total cleanings, and 1 visit to fill 2 minor cavities.  And hopefully neither of us need any more dental work before 2020 or that will be an extra charge.  $500 seems a bit excessive for that amount of work. 

[EnjoyIt]

I pay roughly $242/yr for dental insurance through my employer for my whole family.  Currently only my wife and I use it, as my son is only 16 months old.  Coverage is either employee only, or employee + family.  Seems fairly reasonable to me assuming we get 4 free cleanings per year, and in the event of needing dental work get a substantial discount ($50 deductible, then 10% coinsurance via PPO).  Plus that $242 is all pretax which is nice.

If I stick with my current dentist for the cavity work I need done I'll be up to around $260 for 2019 so far I think.  That's $500 total for dental work, which is going to include 4 total cleanings, and 1 visit to fill 2 minor cavities.  And hopefully neither of us need any more dental work before 2020 or that will be an extra charge.  $500 seems a bit excessive for that amount of work.

How much in addition is your employer paying for your dental insurance?

There is no free lunch and the insurance middleman wants their cut. Their participation and their cut costs money increasing the cost of dental service delivery. Insurance dental care payment service isn’t free you know.

[frugalnacho]

I pay roughly $242/yr for dental insurance through my employer for my whole family.  Currently only my wife and I use it, as my son is only 16 months old.  Coverage is either employee only, or employee + family.  Seems fairly reasonable to me assuming we get 4 free cleanings per year, and in the event of needing dental work get a substantial discount ($50 deductible, then 10% coinsurance via PPO).  Plus that $242 is all pretax which is nice.

If I stick with my current dentist for the cavity work I need done I'll be up to around $260 for 2019 so far I think.  That's $500 total for dental work, which is going to include 4 total cleanings, and 1 visit to fill 2 minor cavities.  And hopefully neither of us need any more dental work before 2020 or that will be an extra charge.  $500 seems a bit excessive for that amount of work.

How much in addition is your employer paying for your dental insurance?

There is no free lunch and the insurance middleman wants their cut. Their participation and their cut costs money increasing the cost of dental service delivery. Insurance dental care payment service isn’t free you know.

I have no idea what they are paying on my behalf.  It's a sunk cost though.  If I opt out of dental insurance I don't get their portion added to my check.

[Dicey]

Yeah, THANKS, Obama!! </sarcasm>

Who knew that dental care was so complicated?

Sorry, @elysianfields, I understand that "</sarcasm>" means that you're joking, but could you please explain it to me? I just don't get it.

[Metalcat]

It is such a shame that the insurance industry is squeezing its way into dental care.  It was much simpler and less expensive before they arrived.  But such is always the case when we add a bookie in between every transaction.

Dental insurance is a new thing??

We have private dental insurance in Canada and we have none of this in-network stuff. Dentists are all "fee-for-service" here, the fee is the fee is the fee regardless of insurance and anyone can see any dentist or hygienist and get the exact same reimbursement amount.

Can someone give me a crash course as to how insurance is "squeezing" into dental care? What did you have before? Is dental part of the ACA? Is that part of why it's so complicated?

Why do you need a bookie to skim money off the top of a dental transaction?  Before insurance you went to the dentist, wrote a check and went home.
There is no need to pay a coder and biller to figure out how to bill the procedure, send it in to an insurance company, have someone at the company evaluate the claim and then send money if they deam worth it.  Otherwise the claim is denied and the biller/coder needs to figure out why and send it back again.  Plus the insurance company wants to make a profit taking some money off the top of this transaction.  Why is all that necessary?  Can't I just write a check to the dentist and move on with life?  That is how it has always been years ago.

Dental insurance for adults is a scam as there is no need for insurance.  You buy insurance to insure against a claim that you can't afford.  This does not exist for dental care.  You don't need insurance to clean your teeth or have a cavity filled. It is not like there is some dental emergency that can run up a $100k bill.

I'm unaware what happened before dental insurance, because being only about 40 years old, and being aware of having dental insurance for at least 30 years, I can't tell you how it 'used to be'.

I will say that dental insurance 1) negotiates a lower rate than if I didn't have it, and 2) transfers some of the cost to the company. I pay about $300 in premiums in a year and receive about $2,000 in services.  As for dental emergency that runs up a $100k bill; I know some people for whom that did exist... (basically their entire mouth had to be reconstructed after an accident) and the negotiated rate by the insurance company helped greatly.

See, we don't have negotiated rates here.

I totally agree with EnjoyIt that dental insurance isn't really necessary, at least not here. It doesn't do all that much for people here, and if they need a lot of work, it's mostly out of pocket. That's why almost no one here has dental insurance unless it's through their employer.

That wasn't what I was asking though, I was asking if there was something different about dental insurance in the US recently. EnjoyIt's statement about insurance "squeezing" into dentistry implies something that is a recent/current process. So I was confused.

Dental insurance has been around here for a very very very long time, so a world where dental was cheaper without it just doesn't exist in our modern cultural memory.

Many dentists in my area do not take insurance. Their practice is full, have less overhead and one dentist I spoke with says he makes more money while charging less for his services (I suspect that is universal but have no way to prove it.)

Taking insurance is great for a starting practice as it helps attract volume. 

Most people don’t buy insurance unless it is offered very cheap by their employer.

@Malkynn, how much do you pay for the insurance and how much does you business pay?  Would you rather get that cash and then go to a dentist that does not take insurance and charges less? As for a dental emergency, it really isn’t a dental emergency if it is trauma which a dentist doesn’t do. You are describing a maxilofacial surgeon for which I believe health insurance would/should take over. Correct me if I am mistaken.

The dentists I know in the states who don't take insurance actually charge a lot more...

Also, I don't know about the US, but oral surgeons here are private. There are some in hospitals, but very few and most oral surgery is out of pocket/paid through insurance, even if it is a genuine medical emergency.
Also, most dental emergencies are dental, so treated by dentists.
Plus, I never described anything about dental emergencies...so I don't know where that came from...

Me? I don't pay anything for insurance, I'm self employed, and I go to a dentist that charges 20% above the provincial fee guide, to everyone, regardless of whether or not they have insurance. Dental insurance for individuals here is not a good deal, I already said that above.
Group insurance is a VERY GOOD deal for employees here in Canada if they use it for dental, vision, orthotics, physio, massage, psychology, and prescriptions. I get very VERY good value from the small premium we pay to have me on my DH's insurance. They've paid out thousands so far this year. Group insurance is profitable because most members won't bother using it. It can be an AMAZING value if you actually use it.

Remember, our private insurance doesn't have to cover medical because we have universal healthcare, so our group insurance premiums are pretty damn low. I live in a different world than you do where everything to do with healthcare is less complicated, even the private stuff.

I never even said that insurance was good or bad, I simply said that the "fuckery" going on in the initial post is not a product of insurance companies being involved in dental care, because we have dental insurance in Canada and we have none of this "fuckery" about which providers people can go to and price differences for different insurance plans, etc.

The "fuckery" described is NOT a product of a having an insurance system, it's the product of having an insurance system that DECIDED to be complicated. There's no reason insurance has to be that way, it's just how your insurance industry decided to go, and it's kind of whacky.

[elysianfields]

Yeah, THANKS, Obama!! </sarcasm>

Who knew that dental care was so complicated?

Sorry, @elysianfields, I understand that "</sarcasm>" means that you're joking, but could you please explain it to me? I just don't get it.

Which part?

I found "Thanks Obama" meme writeups at Know Your Meme and Wikipedia

The </sarcasm> comes from HTML, where stylistic mark-up often uses open and close tags, e.g. the beginning and ending of bolded text is bounded by <b> and </b> tags.

As to the "Who knew..." quote, I was pointing to a certain person's infamous statement back when Republicans were attempting to repeal and replace Obamacare.

Hope that clarifies things.

[Dicey]

Yeah, THANKS, Obama!! </sarcasm>

Who knew that dental care was so complicated?

Sorry, @elysianfields, I understand that "</sarcasm>" means that you're joking, but could you please explain it to me? I just don't get it.

Which part?

I found "Thanks Obama" meme writeups at Know Your Meme and Wikipedia

The </sarcasm> comes from HTML, where stylistic mark-up often uses open and close tags, e.g. the beginning and ending of bolded text is bounded by <b> and </b> tags.

As to the "Who knew..." quote, I was pointing to a certain person's infamous statement back when Republicans were attempting to repeal and replace Obamacare.

Hope that clarifies things.

From your source: "Thanks, Obama!" is a sarcastic expression used by critics of President Barack Obama to blame personal troubles and inconveniences on public policies supported or enacted by the administration.

Obamacare doesn't include adult dental insurance.

Therefore, I am still confused as to where exactly the sarcasm was being directed. This is possibly as a result of my favoring the Low Information Diet, as espoused by our fearless leader.

I suspect we may be in sync in regards to our estimation of said other individual, so I believe potential for abiding amity between us exists.

[I'm a red panda]

Yeah, THANKS, Obama!! </sarcasm>

Who knew that dental care was so complicated?

Sorry, @elysianfields, I understand that "</sarcasm>" means that you're joking, but could you please explain it to me? I just don't get it.

Which part?

I found "Thanks Obama" meme writeups at Know Your Meme and Wikipedia

The </sarcasm> comes from HTML, where stylistic mark-up often uses open and close tags, e.g. the beginning and ending of bolded text is bounded by <b> and </b> tags.

As to the "Who knew..." quote, I was pointing to a certain person's infamous statement back when Republicans were attempting to repeal and replace Obamacare.

Hope that clarifies things.

From your source: "Thanks, Obama!" is a sarcastic expression used by critics of President Barack Obama to blame personal troubles and inconveniences on public policies supported or enacted by the administration.

Obamacare doesn't include adult dental insurance.

Therefore, I am still confused as to where exactly the sarcasm was being directed. This is possibly as a result of my favoring the Low Information Diet, as espoused by our fearless leader.

I suspect we may be in sync in regards to our estimation of said other individual, so I believe potential for abiding amity between us exists.

You missed this part: "The phrase is often used to caption animated GIFs in which the subject appears to be struggling with a rather simple task, satirizing those who scapegoat Obama as the cause of problems for which he has little or no influence."

Thanks Obama originated by people who meant it; people who were really blaming Obama for their issues.  Now, "Thanks, Obama!" is also used sarcastically by people who are generally supportive of Obama to blame ANYTHING on him; because it became ridiculous the amount of things critics blamed on him.

For example, I ran out of milk this morning- "Thanks, Obama".

Because he was blamed for EVERYTHING, and in some cases, is still.

So it's more "wow, dental insurance sucks, Thanks Obama" - it has nothing to do with Obama at all. 

[Dicey]

Yeah, THANKS, Obama!! </sarcasm>

Who knew that dental care was so complicated?

Sorry, @elysianfields, I understand that "</sarcasm>" means that you're joking, but could you please explain it to me? I just don't get it.

Which part?

I found "Thanks Obama" meme writeups at Know Your Meme and Wikipedia

The </sarcasm> comes from HTML, where stylistic mark-up often uses open and close tags, e.g. the beginning and ending of bolded text is bounded by <b> and </b> tags.

As to the "Who knew..." quote, I was pointing to a certain person's infamous statement back when Republicans were attempting to repeal and replace Obamacare.

Hope that clarifies things.

From your source: "Thanks, Obama!" is a sarcastic expression used by critics of President Barack Obama to blame personal troubles and inconveniences on public policies supported or enacted by the administration.

Obamacare doesn't include adult dental insurance.

Therefore, I am still confused as to where exactly the sarcasm was being directed. This is possibly as a result of my favoring the Low Information Diet, as espoused by our fearless leader.

I suspect we may be in sync in regards to our estimation of said other individual, so I believe potential for abiding amity between us exists.

You missed this part: "The phrase is often used to caption animated GIFs in which the subject appears to be struggling with a rather simple task, satirizing those who scapegoat Obama as the cause of problems for which he has little or no influence."

Thanks Obama originated by people who meant it; people who were really blaming Obama for their issues.  Now, "Thanks, Obama!" is also used sarcastically by people who are generally supportive of Obama to blame ANYTHING on him; because it became ridiculous the amount of things critics blamed on him.

For example, I ran out of milk this morning- "Thanks, Obama".

Because he was blamed for EVERYTHING, and in some cases, is still.

So it's more "wow, dental insurance sucks, Thanks Obama" - it has nothing to do with Obama at all.

That's what I was trying to figure out. I couldn't tell in which direction the sarcasm was directed. I think it was the use of the open and close tags that threw me. Thanks for your input, @I'm a red panda.

[Metalcat]

Yeah, THANKS, Obama!! </sarcasm>

Who knew that dental care was so complicated?

Sorry, @elysianfields, I understand that "</sarcasm>" means that you're joking, but could you please explain it to me? I just don't get it.

Which part?

I found "Thanks Obama" meme writeups at Know Your Meme and Wikipedia

The </sarcasm> comes from HTML, where stylistic mark-up often uses open and close tags, e.g. the beginning and ending of bolded text is bounded by <b> and </b> tags.

As to the "Who knew..." quote, I was pointing to a certain person's infamous statement back when Republicans were attempting to repeal and replace Obamacare.

Hope that clarifies things.

From your source: "Thanks, Obama!" is a sarcastic expression used by critics of President Barack Obama to blame personal troubles and inconveniences on public policies supported or enacted by the administration.

Obamacare doesn't include adult dental insurance.

Therefore, I am still confused as to where exactly the sarcasm was being directed. This is possibly as a result of my favoring the Low Information Diet, as espoused by our fearless leader.

I suspect we may be in sync in regards to our estimation of said other individual, so I believe potential for abiding amity between us exists.

What she said.
I'm so confused.

[jlcnuke]

What a timely thread....

So, I'll be working from home the rest of this week since I had a tooth infection that required getting one of my wisdom teeth pulled today. A few years back I had two teeth pulled and implants put in. The total cost of all the procedures was a bit over $9k.... my insurance through work paid a bit over $700. What I then discovered in my research is that most dental insurance plans are barely going to save you any money (if at all) if you just go get your exam and cleanings each year. Paying out of pocket would cost about the same.

However... I then found out about other plans that are offered which are NOT insurance, but function similarly. So, to get my extraction and infection cleanup/drainage, under complete anesthesia today would have been ~$1,060 without anything (and ~$860 with my old insurance plan), cost me $583 instead. I highly recommend looking into if your dentist office offers/accepts any such plan. I'm using DentRite Plus

[EnjoyIt]

I pay roughly $242/yr for dental insurance through my employer for my whole family.  Currently only my wife and I use it, as my son is only 16 months old.  Coverage is either employee only, or employee + family.  Seems fairly reasonable to me assuming we get 4 free cleanings per year, and in the event of needing dental work get a substantial discount ($50 deductible, then 10% coinsurance via PPO).  Plus that $242 is all pretax which is nice.

If I stick with my current dentist for the cavity work I need done I'll be up to around $260 for 2019 so far I think.  That's $500 total for dental work, which is going to include 4 total cleanings, and 1 visit to fill 2 minor cavities.  And hopefully neither of us need any more dental work before 2020 or that will be an extra charge.  $500 seems a bit excessive for that amount of work.

How much in addition is your employer paying for your dental insurance?

There is no free lunch and the insurance middleman wants their cut. Their participation and their cut costs money increasing the cost of dental service delivery. Insurance dental care payment service isn’t free you know.

I have no idea what they are paying on my behalf.  It's a sunk cost though.  If I opt out of dental insurance I don't get their portion added to my check.

You do realize that it is coming out of your paycheck.  They may not directly deduct for it, but they definitely pay you less.  Sure, most people don't have the option to opt out of their dental plan and get higher wages.  But the fact remains is the insurance company is making a profit because they are the broker in the middle of a dental transaction taking their cut. 

Just like eye/vision insurance, dental insurance in the US is kind of a scam.