Dental Insurance/Vent/Rant

[FormelyCA 0]

I couldn't find an older thread on dental insurance, so thought I would start one. This could very well go in the vent forum. But this kinda serves as a headsup for all fiances entering on spouses dental plans.

I regret not looking into it and assuming that dental insurance meant that you were completely covered. I naively hadn't even thought of the possibility that there may be a cap on it.

Backtrack - I have known for a year now that I have needed some work done on a couple of teeth. I shopped around for dentists in Korea and didn't love how they did stuff, so I just got done one root canal, thinking I was going to be married soon and on my new husbands wonderful dental insurance plan and everything would be glorious with my new grill

In Canada after I got back from Korea, I went to a dentist and paid out of pocket for cleanings/TEMPORARY fillings (because I informed my Canadian dentist that he should "only do what you need to do to hold me over. I will have my husbands wonderful dental plan soon enough!!". Which BTW 1 temp fell out a week later (supposed to last a year) and the other one is gone (no clue when that came out, I guess I had resin for dinner one night ) so, $500 wasted. But I digress....

Ok fast forward. I go to the dentist yesterday to finally get things sorted out. I walk in confidently that my husbands wonderful dental insurance plan will cover everything. I have had about 5 xrays of my teeth in the last year so I knew everything they were telling me. Hindsight I should have gotten my dentist in Canada to forward me the xrays so I didnt have to pay twice. But, why go through all that hassle when my husbands wonderful dental insurance plan will cover it all!

So, the dentist comes in, tells me all the work i need, 2-3 teeth are in trouble, and i need a crown on the root canal - OK, roger wilco. I knew that. Then the receptionist/insurance lady goes over the bill. As she is talking I quickly scan the enormous paper with enormous fees and find one for PATIENTs OUT OF POCKET - over $6,500!! WTH!!! Ok, what did I miss? Look at it again, insurance covered $1200, I cover $6500??? Ohhhh I know, simple error, she made a typo and got the 2 confused........right?.......right?????

Nope, my husband's wonderful dental insurance has a $1500 cap a year for everything. I never heard of such a thing. Yes, I was naive and didn't do my research. I am from Canada, and while we don't have free dental, I have always heard of dental insurance paying everything (Maybe I am wrong?? I immediately called my parents to ask them what WE had growing up on my fathers dental plan, and they said there was NO cap and were horrified that his dental "plan" has a $1500 cap).

*sigh* it is what it is. Hindsight is always 20/20. When you know better you do better. (I'm trying to make myself feel better The good thing is, I went over the 'work' with them and I am 99% sure that OVER half of the procedures they claimed needed to be done are bogus. I have seen about 4 dentists in the last year and this is the first time I have heard about 9 fillings needed to be done. You would think I eat candy all day and haven't seen a toothbrush since the 90s for crying out loud. I am a solid 2-4 times a day (more recently because of those 3 bad teeth, they kill me sometimes!!).

I shoulda gotten them done in Korea (root canals are free - just pay for crown, still cheaper there though), heck I even should have gotten them done in Canada rather than throwing over $500 for temp stuff because, OH I will be insured in a few months yay!!! Shoulda, coulda, woulda though eh?

I guess this is a warning for all new people entering on their spouses dental plans. Check out the details beforehand. I didn't

Sidenote - what do "secondary" dental plans do? Am I screwed out of getting one now because I am on record as having pre-existing problems? Are all dental plans like this or is my husbands (still feels weird writing that!!!) just a crappy one?

[SapphireDreams 71]

Every dental plan, even in Canada, has a cap. My current dental plan in Canada has a cap of $1200. Sometimes they will add more on for root canals or braces, but I think you'd be hard pressed to find a dental plan in Canada that is unlimited.

Sometimes you can use "flex" dollars to pay for extras as well. I know my fiance was able to get laser eye surgery covered with his 'flex' benefits.

Dental work is definitely not cheap wherever you go. I know my parents have paid quite the pretty penny on my teeth (i've had 2 root canals and lots of fillings). Most of my basic dental work was covered, but we often had to pay a bit more out of pocket.

$6500 does sound like a lot though, you might want to go get a second opinion/price.

[JillA 2]

Oh yeah, most dental plans have a cap, I'd be surprised to hear ones that don't. My plan in Canada had a $1200 cap too, and my husband's is also $1500. It doesn't surprise me, at all. If plans didn't have caps on them, alot of people would probably take advantage of it being "free" and get all their old fillings replaced, etc.

[FormelyCA 0]

Yah i guess I was naive on the whole issue. It was my understanding that CERTAIN things wouldn't be covered, like you couldn't go and get porcelain veneers and like you said Jill, couldn't go and just deicde to get work done that wasn't necessary. But procedures such as root canals and fillings I assumed would be covered since no one would elect to have these done. One root canal alone is $1500 (with crown).

Maybe my parents are wrong and they did have a cap on their but don't remember?? I guess everyone else knows about this cap but me haha

I just wish I had done my research before leaving Korea, where it was a lot cheaper/free. Ugh, c'est la vie!!!

[JillA 2]

Yah i guess I was naive on the whole issue. It was my understanding that CERTAIN things wouldn't be covered, like you couldn't go and get porcelain veneers and like you said Jill, couldn't go and just deicde to get work done that wasn't necessary. But procedures such as root canals and fillings I assumed would be covered since no one would elect to have these done. One root canal alone is $1500 (with crown).

Maybe my parents are wrong and they did have a cap on their but don't remember?? I guess everyone else knows about this cap but me haha

I just wish I had done my research before leaving Korea, where it was a lot cheaper/free. Ugh, c'est la vie!!!

I hear you, it sucks! Yeah my husband already spent his cap for this year, because he also needed a root canal and some other important work done. Unfortunately we've already spent $800 out of pocket and for the rest of the year will too.

[trailmix 77]

Yes that is too bad that it is going to cost you so much!

I also have never heard of a dental plan that didn't have a cap - it's pretty standard. Some are better than others, however for major things like root canals and crowns you almost always end up paying a lot out of pocket.

Edited May 5, 2009 by trailmix

[Hugglebuggles 60]

I hate the dentist so much! Its my #1 fear. I have no idea why, but the only time I ever go is when my mom makes me an appointment and forces my ####### in the car and drives me down there I already told her that when I move to the US I'm just going to let me teeth rot out of my mouth and never go to the dentist again! (Ok, that's a gross exaggeration I know...) But in 21 years i've never had a cavity! I'm fighting the system and winning!!

But yeah, my dads dental plan has a cap of $1200, which I'm still allowed to use until June. It would be SMART to go get a cleaning and stuff done before I move but... see above When I had my wisdom teeth done we had to pay some about $800 out of pocket, nothing is immune from the cap. At least in the US, you don't have to sit on a 4 month waiting list to get the surgery! I had to do that down here while my wisdom teeth felt like they were pushing the rest of my teeth out of my mouth... ugh.

But that really sucks Carrie! Unfortunately, Its one of those things you need to do. If you wait on something like a root canal, it can spread to other parts of your mouth, cause infections... a lot of different problems. Then you'll have an even bigger bill! Maybe the dentist will allow you a very incremental payment plan? Or, go get some other opinions, that's not a bad idea at all.

[Kathryn41 3,205]

I don't know if my dental plan in Canada had a cap or not - if it did, I never reached it. Dental work here is atrociously expensive - far more expensive than it was in Canada. Our plan caps at $1000 and there is a lot that isn't covered, and even for what is covered I still generally have to pay between 20 to 40% of the bill because it only covers at 60 to 80% - and that is an in plan dentist. It covers a heck of a lot less if I go to an out of plan dentist - a mistake I made my first year, although it wasn't necessarily my mistake. I asked if they took my insurance and they assured me they did - what I should have asked is if they were an in plan provider for my insurance - which they weren't. Of course, they never told me that! My dentist has a whole 'to do wish list' that she would like for me to do. I asked her to prioritize it to what needed to be done in what order with the understanding maybe only one or two things get done a year while the insurance coverage lasts. That might be an approach you can try with your dentist. I had two abcessed teeth that needed root canals this year so my money is used up for the year. Hope I don't have any more dental emergencies - I can't afford them - and we do have insurance. I hate to think how people without insurance manage.

[payxibka 10,045]

Yup, I laid out $2600 for a four position bridge as insurance capped out at $1000 annual limit

[Marilyn. 340]

we are still paying off dental work my hubby had done over 2 years ago...

[FormelyCA 0]

Wow!

Yah, I had her do that Kathryn, I told her to prioritize the list for me and I will work in that order. It makes no sense though, in the first tooth, they have some insured and some I pay, and then for the next tooth it is the same, until the rest of my $1500 maxes out (I wasted/used $275ish on cleaning and xrays). But what i don't get is, if they are going to pay $1500 for the year, why not just use it in matter of necessity.order, then when it runs out it runs out. On the first tooth, they pay like $900 or whatever, and then I pay $500 out of my pocket, and then the next tooth they pay $300 and I pay $1100. Why not just have the first tooth completely covered??? Ugh, so complicated.

Yeah, I knew dentistry was expensive here, I just had NO idea there was a cap. Like I said, I'm so upset because I was in Korea for 4 years, where virtually everything is covered (minus crowns and other stuff that is "elective" Crowns aren't "elective"!!!). But, I'm kicking myself for just not getting it done there.

I contacted my Canadian dentist and they will send me my records. I wanna see if he claimed I needed NINE fillings. I KNOW I would remember him saying I had 9 cavities! Unreal. Also, I may seek a second opinion and want to have something to go in with.

Huggles - They have a plan where you can do 2 year no interest payment thing. But, it is principle for me I will be annoyed for the rest of the week at myself. Then, I will figure out what I need to do. I think I may wait until January to do the last root canal. But, I know Huggles, you don't wanna wait too long where it goes to other areas and then makes everything worse!! Which is ALSO why I am kicking myself. I purposely waited (and made things worse perhaps) because I assumed I was going to be 80-100% covered!! Ugh. I could, and probably will just bite the bullet and do all 3 for $3,000. But, my husband made a deal with me that we could spend $2-3,000 on decorating our house to make it feel more homey So, there is my decorating allowance. *sigh*, could be worse I guess. So I need to get off my high horse and count my blessings. Maybe a day or 2 of sulking and then I can move on

[trailmix 77]

What they are doing is what Kathryn mentioned - there is a 'co-pay' if you like on items, so for instance they might pay 80% of any filling (until you reach the cap) - but you are always going to pay the 20%.

One other thing - and this is just an idea - how expensive was your dentist in Canada? Is it possible it would be cheaper to fly back there and have him do the work instead?

[movingsoon1 0]

Thank you for this useful info re dentist in the US.

I just had dental work done in Canada as I fear high prices in the US. I have a teacher's dental plan and have never heard of a cap, I am sure it's unlimited coverage. The plan pays for a monthly premium and then at the dentists it's 80% coverage for fillings, cleaning and root canals. 70% coverage for crowns. I also had a wisdom tooth pulled out (it's all up and grown), cost 100 dollars, 80% covered, so I paid 20 dollars for that.

I told them to keep me in the system as I might go back to Canada for a vacation and have cleaning done for 130$ and fillings for $100 in the future.

[Emancipation 2]

I agree with everyone else.. CDN dentistry is cheaper.. and I'd consider getting our dental work done back home if it was something huge. Hubby had a root canal last year and it was 1200$ (just for the root canal no cap)... our insurance paid for most of the root canal, but wouldn't pay anything for the cap. We're still paying off that one (that was $600.00 or something silly)..

I think some dentists are con artists.. go to 3 different dentists and you'll get a list of 3 different things wrong with your mouth. I just have had bad experiences and totally feel jipped every time I go see one.

Our dentist now is decent.. I'm not 100% happy, but he'll do for now.. oh for my old dentist back in Canada.. he practiced in CA for a long time before moving home to PEI.. he had a super attitude and seemed willing to help his patients.

Edited May 6, 2009 by Emancipation

[FormelyCA 0]

I agree with everyone else.. CDN dentistry is cheaper.. and I'd consider getting our dental work done back home if it was something huge. Hubby had a root canal last year and it was 1200$ (just for the root canal no cap)... our insurance paid for most of the root canal, but wouldn't pay anything for the cap. We're still paying off that one (that was $600.00 or something silly)..

I think some dentists are con artists.. go to 3 different dentists and you'll get a list of 3 different things wrong with your mouth. I just have had bad experiences and totally feel jipped every time I go see one.

Our dentist now is decent.. I'm not 100% happy, but he'll do for now.. oh for my old dentist back in Canada.. he practiced in CA for a long time before moving home to PEI.. he had a super attitude and seemed willing to help his patients.

trailmix - ohhh ok I get it now. That makes sense-ish I think in the end also, it would be roughly the same fee to go to Canada to do it. I wasn't overly paying attention when he was telling me how much it would be, $600 for the root canal sounds familiar, and that is what she is charging me here. Plus, flight etc. Plus, I don't think I can wait another 3 months for my AoS to clear I need to get this done this month - it has been waaaay overdue.

I agree. I mean the thing is they are businessmen/women. So I get it. When i was in Korea I felt that a LOT. So, me being the stubborn person I am, I decided not to give them my business. I realize now though, if I keep up that mentality I will be stubborn.......and toothless When i finally found one I liked in Korea, it was a month before I left and I only had time to get the 1 root canal (free I will say again!! Well, like $20, insurance covered the rest..here that Delta Dental!? - yes, I am still bitter )

I will shop around for sure, and like I said, those 9 "cavities" are not even getting looked at for a year. 5 dentists in 1 year and this is the first I have heard about even having something wrong OTHER than with the 3 teeth I know need done. Grrr.

In the end, it isn't the dentists fault. I mean, when you think about it, they SHOULD charge a lot, otherwise if you didn't know you would make a lot of money, why would you go to school for that long and pay all that money for schooling?? The problem is with the government not subsidizing it. Yes, I am for full government intervention on our lives :D But I don't know. Something needs to be done because dental care should be no different from medical care. It is the SAME thing!!! The teeth are in your body!!

Edited May 6, 2009 by carrieandadrian11