General Question

RandomMrdan's avatar

Is your healthcare and dental insurance provider as terrible as mine?

Asked by RandomMrdan (7420points) February 10th, 2009

My total amount I paid for my dental last year was about 221 dollars. I went for a check up, cleaning, and x-rays. The total bill would have been 151 dollars…but luckily my dental coverage covered a whopping 40 dollars. Am I getting jipped or what?

I paid just under a grand in medical coverage, but haven’t used that.

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12 Answers

RandomMrdan's avatar

it seems if I had gotten 2 check ups in the year, that would put me at about 300 dollars…but now that I have dental insurance, I’m paying 200 plus another 220. Doesn’t make any sense to me at all.

loser's avatar

Most dental plans have a yearly deductible. A certain dollar amount that they refuse to pay straight up. Yours isn’t too unusual there. Next time it should be cheaper, if that is the case. And if so, get as much done as you can in this calendar year.

AlfredaPrufrock's avatar

Dental plans have not kept up with actual cost for services the way that health plans have. Are you covered by a group plan through work, or do you have individual coverage?

RandomMrdan's avatar

group plan through work…I’m very close to ending it though.

chyna's avatar

My group dental insurance pays for 2 cleanings and x-rays in full per year. Then I pay a percentage if I have fillings, crowns etc. So yes, you are getting screwed on your insurance. And it is my choice of dentist, not theirs.

AlfredaPrufrock's avatar

The coverage you have is selected by your employer. The insurance carrier most likely has more robust offerings, but what your benefits administrator selects is what you get. Unfortunately, selections are usually premium cost driven and not coverage driven. Depending on the size of your company, the premiums may either be based on your geographic area if your company is under 100 employees, or on your company’s group claims, if the company is over 100 employees. Many groups do not offer any dental benefits, and we’re seeing more that aren’t offering prescription drug coverage. These are generally separate benefit selections: dental, Rx, medical.

Sometimes you can do better with a dental discount plan.

gooch's avatar

Mine is worse! My Fire Dept provide no dental and sucky medical. My deductable is $1000 per family member then they pay 80% of “customary charges” which there are no doctors around who charge “customary charges”. My wife just had knee surgery and out of the $10000 bill we had to pay $7000.

Darwin's avatar

We have no dental insurance. We used to have it through work but they kept losing my account so we had to argue with them every time we went to the dentist,. They have all sorts of arcane rules that basically mean that they really don’t pay for anything except the two cleanings a year and one set of x rays. I found that for big ticket items I could negotiate a better deal on my own if I would pay cash in a lump sum, which I could out of my Flexible Spending Account.

Our medical insurance is better but has its foibles. We have military insurance so as long as we can go to the base clinic there are few problems. However, if we have to go out in town it gets frustrating but not necessarily expensive, except randomly when someone interprets the rules in a strange way. Unfortunately, due to the Irag War and due also to the economic downturn the base clinic is gradually and sneakily reducing services so we have to go out in town more and more.

However, I am glad we have medical insurance. My brother has none and makes too much money to qualify for CHIP insurance or Medicaid but not enough to pay $1200 a month for private insurance. Fortunately my parents help pay the kids’ bills, his wife at the time was good at having kids so she had them at home with a midwife attending the births, and the Texas Crime Victims Compensation Fund covered my brother’s injuries as the result of a drive-by shooting.

AlfredaPrufrock's avatar

It’s really important to read your certificate of coverage (not the benefit summary that you got at enrollment, but the certificate) because this is your contract with your carrier and spells out how your claims are covered. The most common mistakes that drive up costs for members is 1) failure to get pre-certification for a surgical procedure, if the plan requires it 2) using an out-of-network provider or facility. If there isn’t a network facility in your area, this should be worked out with the carrier before the procedure takes place. 3) the doctor’s office used the wrong medical coding for the procedure (this happens more often than you can imagine.)

Dental insurance has not kept pace with procedures and costs.

Thegary's avatar

There is no such thing as good dental insurance. Period. Most dental plans will cover you for only the most basic services (cleanings, check-ups, etc.). Most companies will offer more extensive coverage in exchange for higher premiums. This usually does not benefit the insured, however. For people who hate the ideas of paying high premiums for low coverage for medical or dental, should look into a Health Savings Account (HSA). I recommend that before anyone does this, they learn all the ins and outs first. HSAs are fast becoming the preferred method of paying medical expenses, since the government keeps loosening the rules that used to limit them.

AlfredaPrufrock's avatar

Thegary, in order to have a HSA, the US government requires that you have to have a HDHP health plan (High Deductible Health Plan), which many employers don’t offer. With a HDHP, you pay the full charges at the network contracted rate, up to your deductible. If you are used to having a copayment plan, then this is a little alarming at first, because instead of paying $20 or $30 for an office visit, you pay the full charges, but at the contracted rate for a network provider. The trick is to fund a HSA at least up to your deductible each year, so you have the money available. Unlike an FSA account, an HSA does not have to be used up each year, and unused balances can carry forward. Given that 60% of the US population uses $600 or less in health care each year, HDHPs and HSAs are a good financial planning tool.

When it comes right down to it, health insurance is a financial planning tool. When you get health insurance, it’s like joining a buying club. You get discounted rates for services from contracted providers and certain preventive services for free.

Talking to dentists about dental coverage is really interesting, because they have a perspective that’s overlooked. Good dental health is an important component of good overall health.

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