r/DentalInsurance

I was quoted $1750. I show up the day of appointment and I need to use SUNBIT, their loan service. I go and apply for $1750 and then the woman tells me there is another updated quote for $1300. I’m like oh shit of great that’s wonderful. Now how do I change my loan amount. “Call SUNBIT they will help you” I do that two days after surgery because I’m out of it. SUNBIT says dentist is in charge of the charges and they can’t do anything. I mean of course you don’t call capital one after buying a car and saying oh yeah the dealership f’d up you can take 5 g’s off. So I go back and tell them. Manager comes out and says nothing we can do until after insurance pays us. We will change it after. I’m thinking this is such a lie they are going to take more money. I just got my patient responsibility in the mail from insurance and I now owe $2200. I’m a father of 2 kids under 4 with a stay at home wife. This is way too much not to be discussed before a surgery.

Smile generations/ Ruby Hill Dentistry/ Highlands dentists

I recently went to Ruby Hill Dentistry in Denver after not seeing a dentist for about two years. I moved and then life happened, other things took priority. Previously I had always gone regularly and I’ve always had great teeth and gums. I floss (being honest, most days) and brush at least twice a day.

I do have genetically receding gums and some root shortening from how my braces were done.

After looking at everyone on Delta Dental USA, and all the reviews seeming subpar, decided to go to the one closest, Ruby Hill Dentistry.
  
They took X-rays and then started measuring my gum pockets. Mostly 4s, 5s and 6s indicating periodontal disease. It also hurt so bad, I could taste the blood.  I had assumed it was because I really messed up by not getting yearly cleanings. They continue to literally do fastest general cleaning I’ve ever had. It was no more than what i do at home.

They then told me I had periodontal disease and needed scaling/root planing and laser treatment. They go on to accuse me of lying about flossing…

They bring in someone to talk finances while I'm in the chair. Never in my life have I experienced a dentist do this. A financial “advisor” tells me ‘she knows I must be so overwhelmed but they are here for me and to help me afford all of this’ They tell me they recommend me doing a deep clean every 4 months. The deep cleanings are around 900$. She then offers Smile Generations Financing which sounded like Klarma… Monthly payments, no interest. Perfect. I didn't plan on spending almost a grand that morning, so why not spend it over a few pay checks? 

I got home and NOPE I realized she sold me on a credit card??? I was so sketched by it. For a dentist to scheme patients into a credit card. I didn't love it, I then questioned using their periodentist. 

I did some research and found someone I felt I could trust. 

I went the same week. He carefully measured my gums and read the numbers out loud. My gums didn’t bleed, it didn’t hurt. The numbers were nowhere near what the first dentist had told me. I asked whether the cleaning I had just received could have caused the measurements to improve that dramatically and he told me probably no. Then told me overall my gums were healthy, just maybe slight gingivitis in the back. The only thing I actually needed was one gum graft, which was exactly what I had originally gone in knowing.

Come to find none of it would be covered by insurance so I had to find another periodontist…

Every single periodontist on Delta Dental USA is on smile generations.

I tried to find the one that works with another practice, and not just with Smile Generations. I go to Highlands Dentist.  

I explained the situation and that I'm hoping my second consult was correct. He then continues to basically gut out my gums by probing, so much so the next day it hurts to chew. He tells me the original dentist’s measurements were accurate… Something I took note of was when he saw the original dentist’s name on my file he commented it like he personally knew her which automatically gave me an off vibe since I was questioning those results.

He recommended a gum graft and four bone grafts. I got the same smile generations financial spiel but with included personal discounts because it was still so expensive.

I get home, so upset again and I call my aunt who used to be my dental hygienist back home. She immediately thought the treatment sounded extreme and sent my information/X-rays to a periodontist she trusts. They both automatically said to get another opinion. He also commented that it seemed like my gums may have been probed aggressively enough to cause bleeding and that based on the X-rays.

Still being dramatic over it all, I tell my friend about it all. She immediately says “Get a second opinion. This sounds exactly like what happened to me at an office off 38th.” She had gone to highland dentists…  

Her story was she had spent thousands of dollars there and eventually switched dentists. Her new dentist told her that her gums were healthy and that much of the treatment she had received wasn’t necessary.

She also told me her office was eventually investigated after another patient alleged that unnecessary dental codes had been billed. As part of that investigation/review, she received money back for treatment she had already paid for.

And now today…

I overheard a coworker talking about her experience at a dentist. She was told she needed a bunch of fillings and deep cleanings the past few years. The most recent filling, she was told a month later she needed a root canal because the filling was done poorly… They were the ones who did it... She then decided to change dentists. There she was told that the root canal was unnecessary and she didn’t have periodontal disease.

Then I told my boss what had been happening.

She said the same thing happened to her. Deep cleanings, switched offices and no periodontal disease.

I’ve also started looking at reviews.

I noticed that the Yelp reviews were dramatically different from what I was seeing on Google.  
And it seems bad ones on Google keep disappearing… ones I do read that’s aren’t 5 star BS seem to have similar situations.

SOOOO 

Is there enough here to worth reporting this somewhere or investigating further? Is it actually worth it… idk all kinda seems messed up to pry on vulnerable patients, who don’t have a degree in dentistry. All while smile generations seems to have bought out every dentist on HMO Plans.

I do plan to switch my insurance the minute I can but Dentists trying to bring in money while forcing test results and misleading patients into medical procedures they don’t need or should have doesn’t seem ok.

Do more people have similar stories if it is worth investigating?

What would one even do if they want to report this? Is it worth getting involved? Could we as one build big case? 

(If you saw my last post.. sorry I am tired. I promise no more AI. I do math and google AI said my OG message sounded bad. But ok, You win. Reddit SAID NO AI…. It’s also much longer because idk how to summarize. So you are probably not reading) but

Is there a good or logical reason why this procedure is typically not covered? My tooth is getting absorbed and I need the graft in order for the implant to be successful. My insurance told me it’s just not covered and it’s not their fault that some procedures are just not covered. I assume they just don’t want to pay, duh, but when I suggested that a graft could be medical, she said it’s not medical, it’s dental, and it’s just not covered. But why?

I recently moved and changed dentists. I scheduled appts for myself and 2 kids for an in network dentist. After visit I received a letter from the dentist stating that dentist would be going out of network but nothing should change with routine cleaning as those visits are usually covered. I took this letter as word and should have called insurance to confirm but did not (I accept full responsibility on this). I kept my kids appts because they are hard to get and I didn’t want to have to delay if I didn’t have to and letter made it sound like there’d be no issues. 1st son went, no issues with billing. 2nd son goes a month later and insurance rejects the bill. Dentist sends me a bill showing no payments and a negotiated balance of $140, down from $268. I call insurance to inquire and they paid $68 from negotiated amount. Now I get a bill 2 months later and they say I now owe $200, which is not the negotiated rates. My son is 4 and he had a basic cleaning, dentist looked at his teeth for 2 mins and he had fluoride. This is insane. Our previous dentist without insurance was $100 for kids appts which included all of the above plus X-rays. I feel that they should a least honor the negotiated rates especially since the first bill reflected this amount and their out of network letter was misleading.

Tips for negotiating?

A big piece of my upper back right molar chipped off, very ragged but thankfully not exposing any gum. Still it's a decent portion gone.

Dentist took x-ray and picture to send to my dental insurance for pre-authorization to get a crown. My insurance would cover 50%.

Claim is being denied because "Based on the information submitted and reviewed by our consulting dentists, no benefits can be allowed for this procedure because there appears to be insufficient evidence of extensive loss of tooth structure due to decay or fracture."

Trust me it's extensive. Dentist has taken more photos and re-submitting. Any one ever been approved after being previously rejected?

I have had two different dental plans from my two different health care job neither of them included adult orthodontics. is this a normal thing? do you guys have coverage? I have very bad bottom row with my teeth and it only gets worse in time.

My husband just got a root canal. He needs the build up and crown, but our insurance will only cover about $100 more of work. Paying $1200 out of pocket is out of our budget right now so I’m trying to find a way to make this work so his root canal doesn’t fail.

He is starting a new job (we are moving states) and will have access to new dental insurance in 10-11 weeks that will reset the maximum.

Our current dentist said he understands the insurance and cost issue. He said we could do the build up only (less than 3 weeks after the root canal) and then wait a little bit on the crown. He wouldn’t give a timeline for how long to wait between build up and crown… would waiting 10-11 weeks be feasible?

Additional details:
My husband is 24 and has never had dental insurance until now.
This is for a back molar. He got a filling a few years ago that fell out about one year ago. He essentially avoided using that side of his mouth for a year. Then the tooth chipped and that prompted me to help him figure out how to use his dental insurance and get a root canal.
We have a new baby and are about to move across the country so there’s a lot going on and I’m trying to find the best financial options that don’t put his health at risk.

I wanted to start Invisalign treatment as an adult, but I'm a bit concerned about my insurance coverage. I think I have 8 months left on my current plan that will cover $2500 maximum lifetime for orthodontic coverage. My question is, does insurance pay that out once I start treatment, or is it over time? What happens if my insurance lapses in the middle of treatment? Can I work with my provider to charge it upfront? Thanks!

Im a dental professional and whether its in the office or on social media, I see so many patients so confused about insurance coverage and different payment options.

I fear that all of this confusion leads patients to avoid treatment or settle for lower quality care to avoid large bills.

Patients: what part of dental insurance is the most confusing, annoying, or frustrating? deductibles? annual maxs? coverage issues? surprise bills? or something else?

Hi I have delta dental ppo plus premier.

i’m having 3 retained baby teeth extracted + 1 adult molar and a bone graft.

I was quoted $1300 for all of this, everything on there is basically free, besides the bone graft which they are charging me $1000 alone for?

I really don’t understand WHY? Is there anything I can ask my dentist about to get a lower price on the graft…?

$1300 is like my life savings, and I still need a whole other phase of work after this, quoted at another $2000.

what can i do?

Delta Dental Illinois is denying our claims routinely citing arbitrary rules that amount to denial of needed dental care. Wife had two badly cracked teeth each with large very old fillings so in-network dentist recommended crowns and did them. Delta Dental Illinois denies coverage saying "anticipation of future fractures" is not covered, period. That is saying to the patient, go ahead and when your tooth fractures and maybe needs extraction and an implant, then come see what we will deny then. Yet in the same breath they send out emails extolling the importance of preventive coverage. IMO they are on a strategic campaign to deny procedures first and talk later even for employer group members and in-network dentists where the approved rates are already way way low. And Delta Dental is advertising broadly in our local market about how great they are. Hahaha.

Checking to see if this is normal practice. I have DeltaCare HMO (DeltaCare USA). My in network dental office gave me a couple of estimates, and I decided to look into why everything was so expensive. I pulled up my Evidence of Coverage document for the first time ever, and surprisingly, every code listed in my estimates had a much lower price in the document than what I was quoted.

I called Delta directly and they confirmed the office shouldn’t be charging me more than the rate listed in my Evidence of Coverage. When I brought this up with the dental office, they said lab fees aren’t included in that price, so the extra is lab fees. That’s rubbing me the wrong way — the document lists an onlay made from a specific material, so why wouldn’t lab fees be baked into that price already? The office first suggested maybe the document was referring to a different material, then switched to saying it was lab fees.

But I also have an estimate for a filling, which should have zero lab component, and it’s also about 3x the listed price for the same code. If “extra fees” can apply to literally any line item without being disclosed separately, then technically every price in the document is meaningless.

The office got hostile when I pushed on this: if lab fees are really a separate, legitimate charge, why are they billing it under the same procedure code listed in my benefits packet, at one lump price — instead of showing my actual Schedule A rate for that code plus a clearly itemized “lab fee” line on top? Quoting one combined number under a code that’s supposed to have a fixed, contracted price feels like it’s designed to obscure what’s actually the copay versus what’s an add-on, rather than disclose it. They treated me like I was asking a stupid question and handed me a list of community clinics.

I also read in this same document that Delta pays offices a monthly capitation fee based on number of enrolled patients, and that additional office revenue comes from patients paying out of pocket for services. So offices do have a financial incentive to overcharge patients who probably don’t check their benefits package.

Is this an issue with DeltaCare HMO generally, or is it specific to this office?

They are charging me $900 for dental insurance.
Is if possible to opt out of it as an international student ?

Hallo zusammen,

ich bin auf der Suche nach einer Zahnzusatzversicherung für meinen fünfjährigen Sohn, der drei Kreidezähne hat.

Gibt es die Eltern in einer ähnlichen Situation, die mir eine gute Empfehlung abgeben können?

Vielen Dank für Hilfe im Voraus.

I could use some help! I have been current dentist for a few years. This year, my health insurance company changed. A crown had to be replaced and the secretary at the dentist office said I am now out of network and would have to pay $700. My insurance covers out of network dentists but covers less and I have to pay more out of pocket. I paid the $700 and my insurance got back to me and said hey your dentist is still in network. I called my dentist back to share the good news and to request a refund but they said the cash portion is the same and no refund is due. How can I best look further into this and see what the actual cash amount I need to pay? Would it be best to call my insurance back? I haven’t received a bill from insurance. Any help is appreciated.

Hi I live in bay shore SFO. I m currently looking for a dental insurance? Is there anyone who uses dental insurance here? I checked a few dental clinics near my area. But even first appointment for check up will cost $300(including a regular cleaning). I was wondering will I pay less if I have a basic dental plan. I was planning to buy delta dental basic plan. Is there anyone who uses this plan. Please help me. Plus my oral health condition is bad. I got to do dental cleaning (more likely deep cleaning)

I’m in my mid-twenties. I’ve always had dental insurance covered by my employer. As such I’ve never had to pay for preventative cleanings and have gone twice a year. I just switched over to a new job, and they do not offer dental insurance as a benefit. Now I’m looking into getting my own personal insurance just for cleanings and it’s leaving me confused. Would it not be more cost beneficial to just pay out of pocket for cleanings than to have dental insurance with a copay? Some dentists near me are charging around $75 for a cleaning, which is much cheaper than the annual cost of the insurance plans I was looking into?

Am I missing something?