Question re dental insurance

[Valerie226]

It's time to decide if we should continue our dental insurance coverage. I'm not sure of correct terminology here.

With medical claims, the insurance co. gets a huge discount or write off. so for a covered procedure that costs $2000, according to the EOB, the insurance co. has negotiated a price for about half that, so they would pay out about $1000, and we would pay our portion, 10%, 20% whatever is in the contract. I assume that people without insurance would be billed for the whole $2000.

Does dental insurance work the same way as a rule? with the insurance company negotiating reduced prices for members and uninsured people getting billed for the 'full" price? the insurance is expensive and we're trying to decide if it's worth the cost since amounts covered are max $1500 per person in a year.

[blazedog]

Not in my experience. Your insurance could differ of course.

In my experience, if you go to a dentist in network, there is a negotiated rate.

However, I never went to a dentist in network, so what is covered are the "customary and usual rates". These were always significantly lower than what any dentist I went to charged.

For whatever reason, there are many more doctors "in network" on insurance policies unless one opts for a pure HMO.

The whole issue of "customary and usual" is one of the aspects of private insurance which some state are going after. Cuomo in New York has asked the insurance companies to provide their databases and found that they are using rather peculiar ways to calculate "customary and usual" -- what a surprise since one of the database companies is a subsidiary of a major health insurance company.

Whether it was worth it, really depends on the numbers. When I had corporate insurance, it was always worth it since the amount I paid out for my premium was far less than what I saved -- even though I still had to pay a significant amount.

[ktg0930]

OUr dentist is no longer a preferred provider in our plan. They still submit to our insurance, but they are paid at 80% of the usual and customary (at least for regular cleanings). We are responsible for the 20% and for the difference between what is billed to the insuance and the usual and customary. For example, the dentist billed $100 to insurance. The usual and customary is $80. The insurance pays $$64.00 to the dentist. We owe $16 (20%) + $20 (difference between billed and U+C) to the dentist.

That's how our dental insurance works.

[Valerie226]

We both get two cleanings and general prophy. mine is usually covered but it's part of the $1500 max. DH has teeth like balsa wood that need extras, and is usually not covered completely.
If you get almost ANYTHING else done during the year you exceed the $1500 max and then it's out of pocket. we're used to paying, and unless the procedure is deeply discounted by the insurance company we are basically wasting the money on premiums. we are waiting for some detailed info on our pending premiums for this 2010, and they seem to have gone up quite a bit. I had a filling replaced a couple years ago and they would only pay for the cost of a silver amalgam... most dentists don't do anymore.... so even though I was far from the maximum they covered almost nothing. we are getting a distinct sense of being jerked around with expensive coverage that doesn't cover much.

[LakeMartinGal]

Most of the dentists that I've talked to say that dental insurance isn't worth it for most people. We use a fee-based plan (from dentalplans.com) and have been very satisfied. They have negotiated a rate with the providers, and everyone with that plan pays the same rate. You only pay for what you need, instead of paying a premium each month, and never needing anything!

[blazedog]

If you are exceeding the $1500 max, that means the insurance company is paying you the equivalent of $1500 per year. If this exceeds your premium, then it may be worthwhile.

Dental insurance is really not at all like medical insurance. I think it's really only purchased by those who are getting it through a corporation because the amount paid in a corporate plan is generally pretty minimal so anyone is going to be better off paying the amount of the premium not subsidized by the employer -- as well as having the benefit of a lower premium to begin with.

Most people I know have private health insurance SOLELY in the event of a medical catastrophe because between high co-pays and high deductibles, most people with private insurance pay much more in premiums than they get back in medical care each year.

However, the consequences of not having medical insurance are far more significant than not having private dental insurance --- especially since any major procedures aren't covered by dental insurance anyway.

It's kind of the flip of private medical insurance where most of us have to pay for the small stuff unless we are really sick whereas with dental insurance, you're covered for the small stuff but not for major stuff.

ETA - Not sure if I was being clear -- I don't know anyone who buys private dental insurance between most people can self insure for the $1500 so the premium isn't worth it.

Most people absolutely need medical insurance because it will kick in when you have high medical expenses -- but you are self insured essentially for the first $5000 or so -- between co-pays and deductibles.

[tbb113]

I had very low cost dental insurance from my part-time job but didn't qualify this year as my hours were too low. I chose to self-insure because by the time I paid the premiums at my regular job, I wasn't coming out ahead. Do the math and see if you are saving money by having the insurance or if you are better off without the insurance.

[Valerie226]

we're waiting for the new numbers right now. last year was barely OK, and we think higher numbers will make it better to drop the coverage. I will check with my dental office re billing practices. I know them well enough to get a clear answer.

we woiuld NEVER consider dropping medical coverage. I about broke the bank this year for the first time. totally unexpected issues came up.... and they were expensive issues.

[blazedog]

Originally Posted by Valerie226

we woiuld NEVER consider dropping medical coverage. I about broke the bank this year for the first time. totally unexpected issues came up.... and they were expensive issues.

I didn't mean to imply that you would. I was just comparing private dental insurance (which isn't worth it for most people) because essentially it pays for what most people can afford versus medical insurance which pays for amounts which would bankrupt most people.

Also, medical insurance is more widely accepted in terms of negotiated rates so that the same services at the same hospital will cost an uninsured person much more than the rate charged to the insurance company.

I don't know of any dentists that were preferred providers. The list was always very short and the dentists were -- to put it nicely -- in the sketchier areas of towns.