Typo Knig was diagnosed with this, and the insurance company refused to pay - said there wasn’t enough evidence of perio disease. They’d have paid if they admitted it was there. However, since then he’s developed significant enough perio disease that he is in danger of losing some teeth (and is looking at some 'spensive work real soon now), so that should be interesting when they try to refuse.
My experiences in general have been that insurance can lessen the, er, bite of the fees but there are such significant limits that it’s not all that clearcut. We have a 2,000-per-person annual max - which means that a single root canal or crown wipes out most of your benefit for the year. We’ve actually double-insured, temporarily (covered both of us through both our jobs) because we’ve both got some expensive stuff happening this year.
Same with me - of course, I am unmarried and have no kids. I have had a root canal, two teeth pulled, and three or four crowns, all of which were cash, and even if you throw in the costs of all of my dental visits for the past 25 years, it doesn’t come close to what I would have paid for insurance in that time (even if you make the assumption that the insurance would have zero deductible and pay 100% of the costs).
Okay, to be fair, my health insurance started including payments for general dentistry (checkups, cleanings, X-rays, fillings), but even had I had to pay the full amount out of pocket, I still come out ahead.
I’m not denying the existence of periodontal disease. I’m talking about the growing practice of finding it everywhere. Especially by periodontists who shouldn’t have enough business to stay open outside of major metropolitan areas, and factory dental practices who use scripts for diagnosis.
I have double coverage also. The company paid plans usually are the lowest cost type, and are geared towards someone with average teeth. One plan comes from my wife’s job, and I pay for the other one directly. But as long as the insurance costs you less than $2000 a year it’s paying off for you if you know you’ll be getting at least that much treatment in the next year. I may be a bit jaded in all this dental stuff. I didn’t have dental insurance most of my life, but did suffer a bad case of mouth meets road as a child. As a result I’ve paid out over the years … let’s see … carry the one … adjust for inflation … I’ve paid out about 2 gazillion dollars for dental work. So I figure anything that reduces an inevitable cost by any amount to be worth it.
Where the insurance might save: you can get in-network rates (if you go with an in-network dentist), which may be considerably cheaper than “rack rates”.
Whether that’s worth it for most people (i.e. the savings is enough to offset the cost of insurance), it’s hard to tell; if you were having a LOT of work done, it might be enough to make it worthwhile. e.g. if a 2,000 crown costs 1500 with an in-network dentist, and they pay 65% of that, you pay 35% of the 1500 - which is I think 525.00. If the insurance costs you less than 1,475 in a year, then you’ve come out ahead.
If you’re having three crowns done, the in-network rate would be 4500. They pay their 65% up to 2,000 annual max, leaving a balance of 2500 for you. Rack rate for those same 3 would be 6,000. So again if you’re paying less than 3,500 for the insurance, you’re ahead. Tough to know all that in advance, however. And some dentists might give the in-network rate to cash customers.
My biggest problem was the determination of what was covered, and what was not. My wife had a lot of dental work done over her life, and if a tooth had a crown, Delta Dental wouldn’t cover repair if that crown became damaged. They would only repair a tooth once.
First: the State selected Dental Insurance sucks (Delta Dental PPO). I have no choice if I want dental coverage. I even wouldn’t mind paying higher rates for better coverage. It’s just not available to me.
Second: it wasn’t $300 a year ($160 every 6 months). It was $3500-$4000 a year…for lots of little non-covered things (amalgam fillings) above and beyond the usual.
When I’m trying to figure out how to cough up $1400 over two months to cover dental findings that my insurance isn’t covering, I tend to get a little suspicious. Esp when the Dentist is talking about moving up from her $400k house to a $1.2 mill house cross town.
This last event was an emergency cap for my son’s chipped tooth. The Dentist showed up as covered, cross checking, they seemed to get good reviews. Show up and huh…they’re not covered on the PPO plan, Delta Dental wasn’t forthcoming on what rates they WOULD cover, and I’m sitting here with a kid in pain not wanting to take another week to find another dentist.
Go back to Delta Dentals’ website and the only PPO covered dentists look like they’re working put of a puppy mill that got universally crappy reviews.
Bringing me back to my childhood memories of our family dentist…through the rose colored glasses of my memory, the guy was a straight up sadist!
I’ve gone to the dentist and been refused service because I didn’t have a credit card. I had insurance, the dentist was the only one in the area ON that insurance, and as my teeth were ‘too bad for a regular cleaning to do any good’, they insisted on a credit card and a credit check to be sure I could pay for a ‘real cleaning’. They refused to touch me, actually backing away and pointing to the door when I asked if they could just do a NORMAL cleaning and ignore the harder parts.
I really hate dentists. Or dental insurance. Or whatever.
I have the Delta Dental PPO. When I was with a much smaller company, the Delta Dental coverage sucked. Now I’m with a much larger one, the billing lady’s eyes get big when they figure out what little I have to pay them.
One thing I want to point out is, the determination of what’s covered and what isn’t is determined by your employer, when they are shopping carriers. The carriers all propose this level and that level of coverage for this premium or that. Employers can save money on the premiums by disallowing certain spendy procedures. So maybe they’ll allow crowns, but not gold crowns. Or they’ll pay for adult braces but only if deemed medically necessary (to treat TMJ for example).
As far as the quality of dentists in-network, I think that just depends on your area. In my example above, the shyster dentist was out-of-network, while the good dentist was the in-network. I got a much better prognosis with the good dentist and what little work I’m having done is going to cost me far less. The degree of coverage, however, relates back to my employer and the fact that it has thousands of employees nationally, so they got cheaper rates because of the larger insured pool, and thus, were able to include more in the formulary as coverable. A smaller company or public entity (state, city, county, whathaveyou) might not have as many employees and, therefore, covers less for more money.
My opinion is: how good your dental insurance coverage is, is largely dependent on your employer. It may not be Delta Dental that sucks; it could be your employer that sucks. Or it could be Delta Dental too, I’m not ruling anything out.
I feel the same way. However, something else that has to be taken into account is, would it be just you, or are a spouse and children included? I live alone, and haven’t had that many problems (two root canals, two molars removed, and one or two crowns where the root canals weren’t involved) in the past 25 years or so, but if you have to include, say, braces for your kids, that’s another matter.
I might add that another part of the equation is your employer’s desire to offer you this insurance at an affordable employee contribution. When the employer shops around for insurance, they have a price point. True, they will negotiate with the insurers to include or exclude this and that, in order to keep costs down (you had better hope your company has a smart MD or other negotiating on your behalf). If you have an insurance plan that includes a lot, expect your employer to pay more, and thus you will pay more for it as well. A trend you may see in both dental and medical insurance is limiting employees to a couple of pharmacy chains, medical groups, and dentist groups within a specific geography to contain costs. Yes, it is your employer requesting this in order to be able to keep offering you health insurance at a decent price point.
I am 39, i havent been to the dentist since i was 18. My teeth are great,
i didnt have my wisdom teeth removed as they surely would have. They
came in crooked but are perfectly straight now.
Brush your teeth, go to the dentist if you have a problem.
Going every 6 months is a racket.
For you, maybe. And you are either very lucky, have great personal dental hygeine, or both.
For others, not so much. Having had teeth rot in my mouth as a child because the dentist and my parents thought they (the teeth, not the dentist or parents) would be falling out soon anyway and thus not worth the money to fill, I will never, ever omit my twice-annual checkup. A toothache is the farthest thing from fun I have ever experienced. I’d rather birth a baby than have a toothache.
You say they “surely would have” removed your wisdom teeth. Not so. An ethical dentist, like any other ethical medical provider, will not do unnecessary work. I kept all of my wisdom teeth until just recently when one developed a serious problem and had to be removed.
I’ve been told at least a dozen times how fabulous my gums are. Seriously.
ETA: But my previous dentist once told me how nice and white my teeth were, and then five minutes later he tried to sell me teeth-whitening service. Idiot.
I’ve had Delta Dental at nearly every job I’ve had and I’ve never had a problem with costs at all. I’m also lucky that I have an awesome dentist that had never cheated me and gives great advice. I supposed I am in the minority.
And reading this thread made me remember to floss!
Had you just signed up for the insurance? I didn’t buy dental insurance through my employer until I starting having major problems; then, there was a 1-year waiting period before major work was covered. Unfortunately, I needed scaling/planing too, and had to do it on credit because I couldn’t wait a year.
Not everyone needs to go for a cleaning 4x a year. My insurance only covers two, but I go 4x and pay for two out of pocket just to make sure I don’t have any problems in the future.
False. Everybody is differenct; some people have naturally ‘clean’ teeth, as in the don’t tend to get plaque buildup. Some people accumulate it at a great rate and it can cause nasty periodontal disease if there is too much buildup under the gumline.
If the dentists thinks you should go every 6 months, go every 6 months. You’re not proving anything by not getting a teeth cleaning twice a year, tough guy.
Dental insurance is fine if you have a lot of problems to be corrected. I’m paying about $1200/year for the two of us, and am planning to cancel it. My dentist tells me that my teeth are like rocks and will outlive me. Same for my wife. The cost of the occasional filling, and twice/year cleaning for both of us does not even come close to the premium costs plus copay. Even a gold crown (which is now $1200) is only partially covered. I’d rather have the extra money in my pocket.
