Root canals and insurance

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AfterBurners

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It’s nice to have good insurance finally. My recent visit to the dentist revealed I need to get two root canals. I have a great dentist and the last guy he referred me to did an excellent job. In fact they are both good friends and located in the same business complex. Anyway he’s not in my MetLife network, but I was referred to another guy who is, by my dentist. He has decent Yelp reviews, but IDK I feel a little anxious about going to him, not sure why? I guess you get comfortable with someone drilling on your mouth you’re not willing to try someone new, well at least I’m not. My insurance will cover 85% of all in network work and they consider root canals “basic” procedures. Although a crown isn’t and will cover 60%. If I go out of network they pay 80%, but now here’s the catch… of what is considered a reasonable fees for a root canal. So let’s say a root canal is around $1000, so I would be responsible for 15% plus the difference in what the out of network dentist charges, say $1400 plus a deductible of $50 this all considered “non-prefer” not in network. So my costs would be out of pocket $600, verses $150 or whatever the 15% of the job will be? I know money wise it makes sense to go in network, just having a hard time in my head to do it.
 
I think it sounds great. I have no insurance and had 2 root canals and 2 crowns this year at a cost paid by me of $4200.00 What do you pay for insurance?
 
In my experience, the R&C (reasonable & customary) price tends to be ~60% of what most doctors / dentists charge for services.

So, let's say your negotiated R&C with the in network dentist is $1000, and you get 85% coverage, you pay $150, insurance pays $850.

At the out of network place, if my assumption holds, the full fare price is $1,667 and insurance pays $800, leaving you to pay the rest ($867).

However, some dentists will negotiate the price if it is discussed up front. Particularly if it is a cash transaction for them, and you handle the paperwork with the insurance co.

If it were me, I'd go to the insurance-covered shop. You never know what might happen during this procedure, and they may have to perform additional work discovered during the procedure, which really adds up at an out of network place.

Good luck.
 
In my experience, the R&C (reasonable & customary) price tends to be ~60% of what most doctors / dentists charge for services.

So, let's say your negotiated R&C with the in network dentist is $1000, and you get 85% coverage, you pay $150, insurance pays $850.

At the out of network place, if my assumption holds, the full fare price is $1,667 and insurance pays $800, leaving you to pay the rest ($867).

However, some dentists will negotiate the price if it is discussed up front. Particularly if it is a cash transaction for them, and you handle the paperwork with the insurance co.

If it were me, I'd go to the insurance-covered shop. You never know what might happen during this procedure, and they may have to perform additional work discovered during the procedure, which really adds up at an out of network place.

Good luck.

That makes sense when you put it that way.��
 
My employer offers dental insurance, but doesn't contribute toward it. We did the math, the entry level insurance would be $35 or $45 per month and end up costing double or triple what we would pay if we just paid cash in an ordinary year. Major issues like root canals, etc. are covered poorly (if at all) and wouldn't make it worthwhile to keep the insurance just for that. If our son who seemed regularly need $800-900 dental visits were still living with us, that might be a different story but since he's out of the house the insurance just isn't worth the cost. Talk to your dentist. If he was willing to do the work for the amount that the insurance would have paid, and allow you to pay cash, you might have your cake and eat it too. Since dentists own their own businesses (generally) they are often able to negotiate more freely than doctors who belong to groups.
 
To summarize my dental coverage experience would be to say it is akin to car insurance covering oil changes but not accidents.

Crowns & root canals are VERY poorly covered.

My daughter needs extra-ordinary dental care - we looked at the numbers and insurance was a waste of money.
She pays out of pocket and gets a cash discount at her dentists and has been money ahead every year we look at it at re-enrollment time.

YMMV, but look at the numbers.
If all you do is get your teeth cleaned twice a year, pay for it yourself.
 
I'm a Canadian, so there is a difference, although slightly..

Work pays the insurance for the wife & I, for a dentist (benefits package). And I recently had a root canal & crown. 50% for both procedures, up to $2000. The dentist's receptionist made a mistake, which forced me to handle the insurance.. A bit of an eye-opener!! it turns out we have a 'recommended dental fee guide' to which the dentist are base their procedure on. The insurance corps use this as their guide for what the procedures should cost, and then pay the percentage accordingly. But, the dentists can charge whatever they like. The insurance will pay based on the guide, so you end up paying the difference if the dentists inflate their prices (which I found out, mine does, to about 10 - 15%). So, I lost about $250 to the dentist. [The dentist quoted me $2031, insurance pays 50%, but 50% of the guide fees, so I got back about $750, not the $1000 I was expecting.. digging found all this out.. I don't think I'm supposed to know about the guide & such]

So, do I demand the dentist quote me based on the guide for the next visit? do I just quietly find a new dentist? do I find a new dentist, and ask what their policy is in regards to the 'fee guide'?

A co-worker has a great dentist who helps her navigate the system.. "Do this now, and then do that next year, when the clock resets.. Do this , but make an appointment to have X procedure done, and we can group them together under this.." that kind of thing..

I had a dentist a few years ago ask if it was cash or insurance. I asked 'what the difference?" "Well, if you pay cash its $100. but insurance I have to charge you $120.."

it just seems, to me, that for a group of learned professionals, they have a very shady practice, designed to milk the insurance companies..
 
I had a dentist a few years ago ask if it was cash or insurance. I asked 'what the difference?" "Well, if you pay cash its $100. but insurance I have to charge you $120.."

it just seems, to me, that for a group of learned professionals, they have a very shady practice, designed to milk the insurance companies..


Some of that, as you discovered, is because if you pay cash, the transaction is simple and easy. But if the insurance is paying, the dentist has to pay one of his staff for several hours of their time to handle the paperwork.
 
yeah, but it still seems somewhat shady..

Most of this is online now, so whether it's actual dollars, a visa card, or sent off for insurance processing, the keystrokes are about the same, the time take is about the same..

I guess I'm also highly suspect as I don't really care for dentists, and I find the insurance cos make sure they get their fair (fat?!) share. The above example, I was out the initial $2000 for a silly clerical error on the dentist's part. Doing the leg work, which I feel the dentist should have done due to them dealing with them in the past, and not just with me, forced the situation to drag on about 2 months. So, the dentist was paid, the insurance was paid, I had to wait.


Another example:
About 20 years ago, I had a massive tooth ache. Molar cracked. found a dentist. Went to see him, and the root canal took about 3 tries to get right. Done. Crown next. But since I had 100% for minor stuff, he made a pitch that all my fillings should be changed over / redone. Uhm, OK, I thought, he's a professional, he knows best I guess. (and, I was in my late 20's, and half drugged up from the root canal) so I made an appointment. He then proceeded to drill & grind a 1/4 of my mouth. 2-3 weeks later, the next appointment for the next 1/4 of my mouth, and a few week later another appointment. At the start of the 4th appointment, to get the last 1/4 done, I asked him if this was really necessary. He ranted about how I should have called to ask, not waste an appointment, and how dare I use up his time & such, how he knows best, and the process was started, etc etc... He 'stormed' out of the exam room. I sat, then quietly exited the office myself. Never got the crown. Got the tooth pulled about 2 years later.. "Professional"? yeah, maybe in the old west..

Sorry, I'm ranting, and getting a bit off topic..
 
I will add my experience from last week, which just got processed by Cigna.

I went in for routine cleaning and routine x-rays. During cleaning, my crown popped out, so additional xray and work was needed to first determine if the root was sound (thankfully, it was) and clean the area and reattach the crown. Total bill for the visit was a but more than $400. Insurance paid I think $210 and I paid $58 which included a $25 deductible. The rest was written off as contracted R&C discount.

So, the insurance saved me considerably this visit. I may have been able to negotiate fees if I were paying individually, but when you are in the chair facing unanticipated work your negotiation strength is low.
 
I figure I'll stay in the network. The Endodontist that my dentist referred me to seems reputible and had good reviews on Yelp. I think there will be less issues with the insurance staying within the network.
 
I'm a Canadian, so there is a difference, although slightly..

Work pays the insurance for the wife & I, for a dentist (benefits package). And I recently had a root canal & crown. 50% for both procedures, up to $2000. The dentist's receptionist made a mistake, which forced me to handle the insurance.. A bit of an eye-opener!! it turns out we have a 'recommended dental fee guide' to which the dentist are base their procedure on. The insurance corps use this as their guide for what the procedures should cost, and then pay the percentage accordingly. But, the dentists can charge whatever they like. The insurance will pay based on the guide, so you end up paying the difference if the dentists inflate their prices (which I found out, mine does, to about 10 - 15%). So, I lost about $250 to the dentist. [The dentist quoted me $2031, insurance pays 50%, but 50% of the guide fees, so I got back about $750, not the $1000 I was expecting.. digging found all this out.. I don't think I'm supposed to know about the guide & such]

We had a similar experience with my wife's fillings. We ended up firing that dentist over the misquoting because it was a lot more money. The new guy is awesome. When we started with him, he was just opening his practice so he did most of the work. He's got hygienists now, but still gives us a fair amount of attention. He also has said more than once that I had a small cavity, but not worth filling until it gets bigger.

Overall, it seems like dental insurance sucks. The OP's sounds pretty good.
 
So anyway I had my appointment today for my root canals. I felt somewhat uneasy because I had a dozen statements to initial and agree to. You know the kind. When getting a root canal you might feel soreness. Another was sometimes during the process your tooth might crack or break off. Another Sometimes dental equipment will break off in your tooth....by this time I was ready to walk out and I did. I called my dentist who referred me to this Endodontics and the receptionist assured me he does great work. She said questions are just standard procedure and they are just there because a lot of people will file lawsuits for no reason.

Anyway I went ahead and had the procedure, I had 2 root canals done at once. Two teeth right next to each other and each one had 4 canals / roots. The numbness is gone and I feel fine. It was two hours to do both teeth and $1800 later of which I only paid $278 and $20 for meds to take. I was given Ibuprofen 800mg and some antibiotics, which I take 3x a day.

Leaves me with about $350 left on my insurance for two crowns. which won't be enough so I'll reach into my pocket, unless my dentist can work with me on a price.

This brings the count to a total of 5 root canals over my life time. Not proud to admit to that, but most of the time I had work done I did have some insurance, but not the best and sometimes none at all. If going to the dentist was more affordable and not so painful in the mouth and wallet more people would go. What bugs me is I floss and brush my teeth at least twice a day. In the morning and before I turn in for the evening and most of the time in between that. I was brushing more, but apparently that was too much?

Without fail every time I go to the dentist I'm always doing something wrong. You brush too hard or you don't floss enough or and I heard this you brush too much or you are brushing wrong. OMG! Can you give some credit for something I'm doing?? Don't get me wrong I like my dentist and been going to him since he bought the existing business some 30 years ago, but give it a rest!

About year and half ago I was told I need night guard because I grind my teeth and wouldn't have believed it, but after he adjusted my bite all that time ago its off again. All these years of my life never had any issues and now my bite is off? Go figure? Yet I don't have any of the symptoms that are related to grinding your teeth. I just can't seem to wrap my head around that, so when I get reloaded on my insurance again in January I have to take care of that as well.

It always seems like a nightmare!

Next up my vision and new glasses!
 
I had a root canal done a few months ago that was years in the making. I finaly had a new dentist when the infection got bad enough to break through my gum line. I was out ~$150 when it was done, not including antibiotics. I LIKE MY DENTIST, weird aint it?! Next up is a crown for a cracked molar. Yeah my ins. is worth it.
 
I remember hearing a statistic, that dentists have the highest suicide rate among doctors...

And, I've often wondered what draws people to dentistry.. Just about everyone hates you (especially kids), and you're constantly putting your finger in people's mouths..

I wonder how many get bitten? And how often..

:D :D


Their chairs are cool though!
 
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