I haven’t had or needed dental insurance up till now. I just went a couple of times a year and paid for each visit. But a while ago my dentist recommended a visit to a periodontist who said I have periodontal disease and recommended a course of treatment that starts with $1,200 of work, with the promise of more to come.
I have been looking at a dental plan offered by my health insurer (BlueCross/BlueShield) for $120/year plus modest co-pays. And it specifically covers pre-existing conditions, which my situation would appear to be. It seems that by signing up, I could save a lot of money.
So is there any reason why I shouldn’t join, go to a new dentist, and get a referral to a periodontist for the same treatment I would have been paying thousands for? (Unfortunately, neither my current dentist nor the periodontist I’ve seen are members of this insurance group.)
Or should I expect the new dentist/periodontist to act more in the insurance company’s interest than mine, and resist embarking on an expensive course of treatment? (Okay, call me cynical when it comes to insurance companies.)
Of course, even if this happens, all I’ll be out is $120 and the co-pays for the first visit or two. If I don’t get satisfaction, I can still pay full price at the first periodontist. So it seems worth a shot.
What’s your experience with dental insurance? What do you suggest?
Dentists aren’t going to be concerned with the insurance company’s interests. They get paid the same either way. You’re more likely to find a dentist recommending un-needed treatments in order to get paid more from the insurance company than you are to find one saying you don’t need a treatment that you actually need. Not that either option is very likely.
I’d say go for it…you’re out a couple hundred with the potential to save a few thousand.
With mine, which is also BC/BS, there wasn’t a pre-existing condition clause as such, like you get with a health plan, but there are waiting periods. It wouldn’t pay for cavities until I’d had it for 6 months, and major work for 12 or 18 months I think. You should double-check to make sure yours doesn’t have waiting periods.
I’d get a second opinion before having major work done. Personally I’m not sure what I want to do with myself. Last time I went to a dentist, they said I had periodontal disease and cavities. This time, they said my teeth were beautiful. Since the last I’d been waiting for that 6-month period, and also flossing and using over-the counter flouride treatment. So, maybe things improved. On the other hand, I’m still sloppy and I fall asleep without brushing, often. I’m not sure what to do now, go for 2 out of 3 opinions?
The first one seemed to want to sell stuff, like braces which offended me. The second one, I got through my plan. Maybe that would make them not want to do pricey things, but I would think that the insurance company has an interest in your long-term health, so they would want to arrest any problems as soon as possible. I’d think that would be more important.
The reason I’m slightly cynical is that a dentist friend of mine said he didn’t like dental insurance plans. His view was that most medical conditions get better by themselves, so HMOs can succeed by making you wait until the condition goes away. But, he said, most dental problems only get worse with time, so an insurance plan’s efforts to delay your dental treatment are a bad idea. And he claimed that that’s what they do.
The cheapest and most common will give you a list of participating dentists, and a list of what you pay- ranging from nothing for an exam or cleaning to a lot for a crown. Really, this is a dental discount plan, where you get a discount for going to a participating dentist, and they get more customers. Thi seems to be what the OP has. In this case, unless you really like your current dentist, then there are no really bad drawbacks. It’s cheap, gets a big discount and all you have to do is switch dentists. They have no reason to delay treatments, as they get paid only if you get treatments. They have a mild reason to suggest treatments that are not 100% nessesary.
Next type allows any dentist, and pays a % (often with a maximum). Generally these exclude certain treatments (crowns, root canals, etc) during your first year. These are great if your company pays for them, which is rare now-a-days. Not so great if you need certain tratments now.
My dental plan covers things like cleanings and x-rays (prophylactic treatment) 100%. There is no co-pay for those. However, for things like crowns they have a standard amount they will cover and you pick up the rest (~50%). I had to pay for my mouthguard in total myself.
I’m very please with it and pay a minimal amount for the plan through my employer.
Dental insurance works best if you keep up regular visits. If you do what I’ve done up to now and wait 2-3 years between visits and then end up having to have a lot of work done in a short period of time, you get screwed, because the maximum benefit is usually pretty low. (Fortunately, professional courtesy is big around here, so it isn’t really costing me very much, even with two fillings, a root canal, and a crown.)
The first plan I had really sucked. It had been (mumble) years since my last cleaning, and I ended up needing two separate appointments’ worth of scaling for a total of $600. My insurance didn’t cover it, because they didn’t cover any “periodontal” procedures. Of course, I found this out after they had done the first half of the scaling.
I have a MetLife plan, which offers three different levels of coverage. Generally, preventative care is well-covered, while other procedures are not covered or partially covered at a rate that sometimes evokes tears of laughter. It’s hard not to imagine that paying $2 for a $150 filling doesn’t cost enough time in processing and paperwork that they’d be better off paying nothing, but I don’t make the rules. it’s not terribly expensive for the basic level of insurance, so I don’t complain much.
My dentist’s complaint about our insurance is that it represents a disconnect between my employer’s values (I work for a University with a major medical center and a dental school, both of which pride themselves in pioneering advances in care) and the insurance company’s standards. I have two molars that need replacing (for example, via implants), and my insurance plan “recommends” a bridge for me, a solution that is patently ridiculous and old-fashioned in my dentist’s opinion. She thinks (and I agree) that my employer should find a plan that better reflects the standard of care its practitioners advocate. I’d certainly pay more for it, if it were available.
I have the world’s worst teeth, so without a dental plan I’d be in the poor house.
But before going into that, be aware that some dentists are scammers. They will recommend stuff you simply don’t need done, just to make more money. And, of course, some are incompetent. You’re at less risk for this, since you’re seeing both a dentist and a periodontist, but you should still get a second opinion. It’s worth your while to know if something really needs treatment, or if it can resolve itself with better dental hygiene.
If you get a dentist you know is really good, hold onto him/her like gold.
Which brings me to my dental plan. It’s MetLife, and they have contracted providers. My dentist, however, doesn’t happen to be one of them, so I pay a bit more for his services. He’s worth it. It pays 50% of expensive stuff (e.g., crowns) whether it’s a plan dentist or not, and most of what I have done falls under this 50%, so I’m really only getting shafted a bit on cheaper things like x-rays and fillings. There’s also a $1500/yr maximum payout, which I actually managed to hit last year.
The plan has been very good about paying out, and I’ve had much less hassle with it (and dental plans generally) than I’ve had with medical.
I don’t know about the pre-existing condition thing. I’ve had just about everything done to me, and I’ve had at least four dental plans in my life, and I’ve never run into a problem getting a payout. If I get into a job without dental, or retire, and have to buy my own, I guess I’ll find out about it.
Cranky: I’d look real hard at the implant solution if I were you. The problem with them is that you’ve got an metal post with surrounded by living gum tissue, and apparently the two don’t get along as well as one might like (this is from my dentist). So implants need a great deal of care to ensure that everything stays clean.
For the two teeth I’ve lost, I went with the bridge. They are no hassle at all (except you may need a floss threader; big deal), and, when it comes to using them, I can’t differentiate between them and a real tooth.
I would add that I had crowns on the surrounding teeth already, so I didn’t need to sacrifice their integrity when I got the bridges. So YMMV.