out of network dr/dentist?

[chiver78]

I just started a new job last week and have been looking at the benefits today. luckily, my Dr accepts the new health insurance provider, but my dentist doesn't accept the new one. however, it is a PPO plan, so in theory I should be able to go anywhere I like.

has anyone encountered this before? how difficult should I expect a reimbursement or whatever to be? should I just call my dentist and ask them these questions? the new insurance is BCBS of Illinois (where my parent company's headquarters are)

I still have 2 weeks to finalize my enrollments, so any insight y'all can provide would be appreciated. please and thank you!

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[Knee Deep in Water Chloe]

How much do you want to stay with your current dentist?
My out-of-network OOP difference is not generally worth staying with a dentist. But, I don't have many issues with my teeth--twice-per-year cleanings and the occasional cavity. 

[chiver78]

well, I have a pretty well documented history of "white coat syndrome" that I have managed to hold off with this dentist office. they took me through my Invisalign treatments, and my dental hygienist knows that I hate the Polish at the end of the cleaning and doesn't give grief about it. that said, they are an hour away now, but I'm really only going twice a year for cleanings.

what sort of charges should I expect if it is all OOP? I think I'll be calling them on Friday when I'm off. I don't really want to change dr or dentist as I've gotten used to both. so happy the dr accepts the new stuff!!

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[chiver78]

they didn't show up in the list. I would definitely call to confirm or deny that before I went looking for a new dentist, absolutely.

the dental insurance where I am now is $6/pay period (single) and 100% covers the basics - which is what I expect to need. I did my Invisalign, and I am not very susceptible to cavities either.

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[Tennesseer]

Chiver-I have been with my dentist for some time.  He is currently in-network but for many years he was out-of-network.  I think insurance paid about 65-70% for my out-of-network dental benefits.

Has/Does your new employer have an employee benefits book to give you or do they have something on-line for you to read?

[Cookies Galore]

My dental insurance is different from my health insurance company (also have a PPO - love it) so can't help you there, but my chiropractor is out of network and she just charges me the $15 copay and submits for reimbursement from my insurance. So far so good. That's all the out-of-network experience I have.
I have been seeing my dentist since college and still see him even though I live 45 minutes away. I would have to give him up!

[wvugurl26]

My dentist is out of network. He was in network when I enrolled and left before my first appointment. I've been going there since I was 8.

They used to pay 100% of cleanings and the percentage of the other categories. Then they enrolled a new dental group and my zip code isn't underserved anymore. My reimbursement last time was at in network rate and it didn't quite cover it.

I pay $17/2 weeks for single coverage. I have the high option so the max payout is higher. I get some vision discounts which is part of why I kept them. I might shop next open enrollment.

As for reimbursement I pay up front and send the form in myself. I think they might be willing to do it but I'd rather do it. I've been doing it for five years now.

[milee]

Chiver, not sure if you get paid weekly or bi-weekly. But if you get paid weekly, your dental insurance costs you $6 x 52 = approx. $300 a year.

If you have healthy teeth and good eating habits so all you ever get are twice annual cleanings and occasional x-rays, the amount you pay for your insurance is more than I pay in cash to get those services from my dentist (no dental insurance) each year.  Without digging for receipts, I think I pay $60 for cleaning twice a year and the few times I get x-rays, those are around $100.  Some dentists will even accept lower payments if you pay in cash at the time of your service. 

In other words, if you're young, healthy and have good teeth, you may not be getting a good deal from dental insurance especially if you'll have to pay some amount to your dentist - copay, OOP charge whatever - on top of what you're paying for insurance.

That's not true for everybody, though.  DH has traditional English (aka - poorly cared for in childhood so ongoing issues for the rest of your life) teeth.  Even though he brushes well and doesn't eat much worse than I do, it's rare that he has a year where he doesn't need a filling, crown, something.  So for him, $300 a year dental insurance would be worthwhile. 

[The Walk of the Penguin Mich]

Jul 20, 2015 18:18:10 GMT -5 milee said:

Chiver, not sure if you get paid weekly or bi-weekly. But if you get paid weekly, your dental insurance costs you $6 x 52 = approx. $300 a year.

If you have healthy teeth and good eating habits so all you ever get are twice annual cleanings and occasional x-rays, the amount you pay for your insurance is more than I pay in cash to get those services from my dentist (no dental insurance) each year.  Without digging for receipts, I think I pay $60 for cleaning twice a year and the few times I get x-rays, those are around $100.  Some dentists will even accept lower payments if you pay in cash at the time of your service. 

In other words, if you're young, healthy and have good teeth, you may not be getting a good deal from dental insurance especially if you'll have to pay some amount to your dentist - copay, OOP charge whatever - on top of what you're paying for insurance.

That's not true for everybody, though.  DH has traditional English (aka - poorly cared for in childhood so ongoing issues for the rest of your life) teeth.  Even though he brushes well and doesn't eat much worse than I do, it's rare that he has a year where he doesn't need a filling, crown, something.  So for him, $300 a year dental insurance would be worthwhile. 

Not quite......

i am now paying cash for dentist, after having insurance for the dentist for the last 35 years.  My first visit to the dentist as a new patient was $300 cash.  I now pay just unde $200 for cleanings twice/year, and because I write them a check rather than use plastic, I get about a $10 discount.

Fortunately, I've not needed anything done but I do have a crown that is going to have to be replaced sometime.  Even paying 50% of the crown would be nice with insurance.

[milee]

Obviously cost of dental services varies depending on where you live, what you require and how much your dentist is willing to negotiate.

My point is that it's worth Chiver taking 10 minutes to call her dentist and figure this out, rather than assume the insurance makes financial sense. Especially if the dentist isn't in network.

[chiver78]

thank you guys, this is exactly what I was asking for in things I need to consider. I'm definitely calling my dentist on friday when I'm off work.

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[tcu2003]

Milee's number matches up with what I pay for my son's teeth cleaning. I called before adding him to my dental insurance, and it was much cheaper to just cover his cleanings than pay the co-pays. It was around $70 for each cleaning. He's only 3, so no x-Rays yet, but I don't think those would make adding him on my insurance worth it.