How to handle dental bills with, or without, insurance
Cost is a consideration when planning dental work. This page explores the many aspects of dental insurance, and how to approach a treatment plan without dental insurance. Either way, your goal is to get a satisfactory result from your treatment while staying within your budget.
How to approach your treatment with no dental insurance:
It is generally accepted that a dentist will make a payment plan and carry out your treatment according to your ability to pay. Any dentist who expects full payment for a procedure before it is completed, is out of line, however, a dentist who wants full payment when the treatment is complete, is not being unreasonable.
Talk to your dentist. Be honest about your finances. See if the dentist is willing to work out a payment plan to match your ability to make payment for completed work.
There are few private dental insurance plans available outside of an employer sponsored plan, however, some good discount plans, such as Careington Dental Plans, can be considered, and will save you money. Remember, a discount plan is just that. You pay for each procedure but at a reduced rate.
Large, well advertised, dental ‘clinics’, which often are franchises, will offer services at slightly (emphasis on ‘slightly’) reduced rates, but you should be careful to make sure that the dentist who treats you is experienced. You want a dentist who has been practicing for a number of years and is a graduate of a recognized dental school.
Insurance rules on billing procedures:
Review your dentist’s insurance billings closely. For almost all insurances, the dentist is not permitted to bill for a procedure until that procedure is completed. For instance, a crown can be billed only when inserted, not when an impression is made. The same holds true for bridges and dentures.
If a procedure is started in one year and completed the next year, the dentist must bill only on the exact date, in the exact year, that the work is finished, not retroactively.
Also, needless to say, insurance is not transferable. A dentist may not bill one person’s treatment on another individual’s plan.
What you should know about your plan:
The first thing to ask is, does my plan pay at the dental office that I am currently attending? Major carriers such as Delta Dental Plan, are widely accepted. In contrast, some ‘self-insured plans’, such as those provided by union locals, are notorious for poor service, failure to make payment, and only accepted by few dentists. If your plan is like that, you have a right to complain to the union. After all, you are the one who is paying for it.
Your dentist should accept ‘assignment of benefits’, meaning, the insurance payment goes directly to the dentist leaving you responsible for the co-payment (the part of the charge that the insurance doesn’t cover). Your dentist should also fill out the forms and submit them for you.
Know your deductible. Learn whether it is a family or individual deductible. A family deductible means that one deductible (often $50 or $100) is used up quicker since one deductible applies together with everyone in the family. Ask if the deductible applies to the exam, cleaning, and routine x-rays as well as to a full set of x-rays. Also, ask if it is a yearly (January-December) deductible.
Also, know your insurance maximum which also may be an individual or family maximum.
Watch your yearly maximum. Many insurances cover $1,000 to $2,000 annually. Discuss with your dentist the treatments that should be done first on the current yearly maximum. Decay, infection, and root canal therapy are examples of priority treatments.
If the insurance maximum is used up, discuss with your dentist less expensive options to get priority work done now while you are waiting for next year’s benefits to kick in.
For example: if you need a front crown, perhaps it might be a good idea to pay for a temporary crown out of pocket and then do the permanent porcelain crown when benefits become available next year. This is an example of smart insurance planning.
Know the percent coverage for each procedure. A standard good insurance will pay 100% for checkup and cleaning, 80% for fillings and 50% for crowns, bridges, and extractions. Be careful to ask about waiting periods. Some plans will not cover crown and bridge in the first year or two of coverage.
If you have a PPO plan and visit a participating dentist you will pay less. If you don’t go to a participating dentist, the fee will be higher and you will pay more.
A DMO plan is less expensive but you may not get the level of treatment that you desire. With these plans, the more treatment you receive, the more it costs the dentist. Therefore the dentist will provide the minimum treatment possible, not necessarily poor treatment, but less treatment.
Beware of free clinics and discount government run clinics. Often they offer a very limited range of treatment options and will not provide the results that you are looking for. For instance, you may desire to save a tooth, but they may only be allowed to remove it.
Finally, do not ever go to an unlicensed dentist or a lab technician for treatment. They are often practicing illegally, and it is almost guaranteed that you will regret the quality (that is, the lack of quality) of their work…and it will end up costing you even more!
