Dentist, "Your insurance isn't a PPO, so take 10% off the coverage."

[SunnyD]

Wait, wut?

Trying to figure out some weirdness at the dentist's office with the price of service.

Cliffs: Time to find a new dentist.

- They tried to tell my wife a filling would cost something like $135.
- The last filling anyone in my family had done was about $84 (last year son had a small filling, poor kid badly needs braces).
- The dentist's office said our insurance only covers 50%, my insurance plan CLEARLY states 80% coverage.
- The dentist's office said our insurance doesn't cover composite at all, my insurnace plan CLEARLY states it covers composite for specific tooth ranges.
- The dentist's office said "Your insurance isn't a PPO, so take 10% off your coverage level right off the top."

The last one gets me... what the hell does that mean? My dental insurance doesn't have "in-network" or "out-of-network" at all, it just covers no matter who you go to. What the hell is this "take 10% off the top" shit?

It's sad, I like the hygienists and the dentist at this office, but if they're going to dick around with the billing and insurance this much just for one filling I'd hate to see if one of us ever needed anything major done. Their front desk has just plain gone to crap over this past year.

/blog/rant

 

[jaedaliu]

hard to believe that there's an insurance provider these days that will pay every provider.

But you're right, time to contact your insurance company and figure out what's going on and who you should see instead.

 

[Vdubchaos]

Fillings cost from $190 to $300 depending on how much work it requires....

 

[Slew Foot]

dentist trying to scam someone? not surprised.

 

[dud]

Fillings cost from $190 to $300 depending on how much work it requires....

Agreed. OP, $135 is a steal for a filling. OP, what "insurance" do you have? Dental Insurance has gotten way too expensive recently so "discount" dental programs are springing up. For example, if a filling normally (uninsured) runs $300 the discount plan would only charge a fraction (say 50%, $150) for the procedure. These discount plans usually run about $150 per year BUT you have to go to a dentist that honors that discount plan.

OP, sounds like your dentist does not want to honor the plan you have (he doesn't have to ... it's his business). Definitely time to find a new, quality dentist that will quote you before they start work, therefore avoiding surprises.

 

[Vdubchaos]

OP, sounds like your dentist does not want to honor the plan you have (he doesn't have to ... it's his business). Definitely time to find a new, quality dentist that will quote you before they start work, therefore avoiding surprises.

Yeah, and good luck on finding a decent dentist.....it's no different than finding a decent mechanic hehe

 

[OutHouse]

find a new dentist. yours sounds like a crook.

 

[OnePingOnly]

dentist trying to scam someone? not surprised.

You're supposedly the CFO of a hospital; isn't your whole career based on scamming Medicare / Medicaid and screwing over your providers?

 

[Anubis]

Yeah, and good luck on finding a decent dentist.....it's no different than finding a decent mechanic hehe

and you would be wrong on both counts
i have a good dentist and a good mechanic

 

[who?]

He probably inflates his list prices 10% so the PPO discount results in the price he would like to get.

 

[jagec]

Agreed. OP, $135 is a steal for a filling. OP, what "insurance" do you have? Dental Insurance has gotten way too expensive recently so "discount" dental programs are springing up. For example, if a filling normally (uninsured) runs $300 the discount plan would only charge a fraction (say 50%, $150) for the procedure. These discount plans usually run about $150 per year BUT you have to go to a dentist that honors that discount plan.

OP, sounds like your dentist does not want to honor the plan you have (he doesn't have to ... it's his business). Definitely time to find a new, quality dentist that will quote you before they start work, therefore avoiding surprises.

That is probably the post-insurance cost...so $270-$675 depending on whether they cover at the claimed 50% or printed 80% level.

 

[TheSiege]

Jesus, I paid 220 for a root canal, people need to start demanding better insurance or find somewhere that provides it. They'll get the picture eventually

 

[Schfifty Five]

Jesus, I paid 220 for a root canal, people need to start demanding better insurance or find somewhere that provides it. They'll get the picture eventually

Damn, that's a steal. Seriously, you won't be able to find prices that cheap unless you have super duper awesome insurance or know a dentist friend who won't charge you much.

I just paid $334 for a root canal and that's b/c I'm friends w/ the dentist and he gave me a nice discount. Add another $330ish for the crown later too. Still, Under $700 for a root canal and crown is a great price.

 

[TheSiege]

Everything is covered at 80% and I have a $50 deductible, preventative is covered at 100%

 

[Slew Foot]

You're supposedly the CFO of a hospital; isn't your whole career based on scamming Medicare / Medicaid and screwing over your providers?

Medical group, not a hospital. Big difference

 

[Schfifty Five]

Everything is covered at 80% and I have a $50 deductible, preventative is covered at 100%

Dang that's nice. Mine only covers major work at 50%. 80% for non-major items (fillings, etc). 100% preventive.

 

[SunnyD]

Everything is covered at 80% and I have a $50 deductible, preventative is covered at 100%

Same as what I have, except I have a 3x$25 family deductible (3 $25 deductibles spread across the family - once 3 deductibles are paid in total by any combination of family members, no more deductible - so basically a $75 deductible).

 

[Baked]

I wish I can name my own price for the different clientele we service like the dentist office. Legalized scamming.

 

[Fritzo]

Yeah, if your dentist isn't in your insurance's list of buddies, expect to get screwed. That happened when I had a cyst removed at a dermatologist last year. They ended up covering everything because they "thought" they were on the PPO list, but they weren't.

 

[SunnyD]

Yeah, if your dentist isn't in your insurance's list of buddies, expect to get screwed. That happened when I had a cyst removed at a dermatologist last year. They ended up covering everything because they "thought" they were on the PPO list, but they weren't.

Here's the kicker - I checked with my insurance, and my dentist is listed by the insurer as a "Preferred Provider". Figure that one out.

 

[Schfifty Five]

Here's the kicker - I checked with my insurance, and my dentist is listed by the insurer as a "Preferred Provider". Figure that one out.

So what did your insurance provider say about this whole thing?

 

[SunnyD]

So what did your insurance provider say about this whole thing?

Why bother asking? If this is the kind of service the office staff is going to give, fighting with them about it is going to be temporary at best. From my OP it's obvious they're stonewalling every time we try to point out where they're wrong. We're just going to look for a new dentist. I have more important things to do with my time than try to fix stupid business practices.

 

[Fritzo]

Here's the kicker - I checked with my insurance, and my dentist is listed by the insurer as a "Preferred Provider". Figure that one out.

If that's the case, you can have your insurance company deal with them. There's some offices that give people crap about having a certain type of insurance because they don't pay enough for procedures. It may be that your dr's office is just trying to extort more money out of you.

 

[SunnyD]

If that's the case, you can have your insurance company deal with them. There's some offices that give people crap about having a certain type of insurance because they don't pay enough for procedures. It may be that your dr's office is just trying to extort more money out of you.

I have a feeling trying to deal with them will be like pulling the proverbial tooth, especially since payment will have to be made at time of service, and once payment is made I'm sure they'll make up whatever excuses they can after the fact.

As I said, we're simply going to let our wallet do the talking at this point and just move on.

 

[yuchai]

Here's the kicker - I checked with my insurance, and my dentist is listed by the insurer as a "Preferred Provider". Figure that one out.

So it sounds like you do have a PPO after all? "Preferred" usually just means in-network.