Question:
I'll skip the details, but my mouth is a mess. I'm about to pick a
dentist in North Jersey and get _a_lot_ of work done. I'm with Met
Life and will use the top end of their reimbursement range, so this is
best case:
1 surface amalgam: $25
2 surface amalgam: $37
porcelin/ceramic crown: $310
Am I about to get hosed?
Also, any guidance on how to have a discussion with the dental office
to the effect that expenses are very tight, so please, please give me
a break.
Answer:
Are those numbers your dentist's fees, the insurance coverage, or your
co-payment.?
A good way: Be available on short notice to cover one of the doctor's
missed appointments in exchange for some discount.
You may want to recheck the insurance. Many have 100% for
preventative, but restorative (fillings) are paid at 80% and crowns,
etc. at 50%.
Some people with extremely good coverage (small town police
departments as example) have 100%-100%-100% but its rare.
I participate in MetLife's PPO plan. Their allowable fees are much
higher than that. What you are quoting is almost certainly the benefit.
Most of their plans cover various services at a percentage of their
allowable fees. For instance, frequently exams, x-rays and cleanings are
covered at 100% of their allowable fee; fillings, root canals at 80%, and
crowns, bridges, dentures at 50%. There may also be deductibles, which
typically aren't applied to preventive services.
Some plans offer a flat reimbursement rate, which seldom covers even
their allowable fee. I would guess you have one of those plans.
Who knows if you are getting a fair deal from the dental office. Very few
dental offices are out to cheat anyone. Just stay away from offices which
specialize in HMO and PPO policies. [Offices which select one or two of
these plans might be very good.] If that level of reimbursement is the
best your employer is willing to pay for, so be it. The employer is like a
household, he has so much money available to spend on employees. He tries
to divide that between salary and tax-free benefits (such as insurance). I
suspect if you had a better dental coverage, you would end up with less in
the pay-check.
If finances are tight, tell the dental office! Find out what the fee will
be for your first visit (to accumulate enough diagnostic information for
them to create a detailed treatment plan for you). Then, you can work out
the details of getting the work done in many different ways. You might be
able to make payments direct to the office, they may offer you a special
credit plan through a company such as Care Credit, you might choose to use
your VISA card, you could go to your bank or Credit Union, you might choose
to do one procedure, pay for it in full, then schedule the next one. there
are lots of options.
