Dental Insurance Waiting Period Details

August 7, 2009 11:14 AM

Another Dental Insurance Question: My Delta Dental starts on Sept. 1st, but they won't cover fillings until Mar. 1. What happens if I have a filling done before Mar. 1?

Obviously, they're not going to cover it, but would I still be able to get Delta's negotiated rate with my dentist? Would Delta pay the dentist and then invoice me to reimburse them? Would I be making life unreasonably difficult for my dentist if I did it this way?

Thanks!

posted by stewiethegreat to work & money (10 comments total)

Have you contacted Delta Dental's customer service line and asked? Definitely, you'll be out-of-pocket for the work. The main question is, as you stated, whether you would have to pay the negotiated rate.
posted by Thorzdad at 11:33 AM on August 7

I have no knowledge of this sort of thing but it might be possible to get the dentist not to bill you till insurance kicks in.
posted by Postroad at 11:43 AM on August 7

You *should* pay a negotiated discount rate but you will have to pay for it yourself - You might want to also ask your dentist if he has other discounts if you didn't have insurance like a student rate or something if applicable. You will pay the dentist directly for it and it won't really make the Dentist's life any more difficult. Since you know it won't be covered you can talk to your dentist about it and he can just invoice you for it at the time of service. Otherwise what will happen is the dentist will submit the claim to Delta and Delta will deny it and send it back to the dentist who will then invoice you for it. Depending on the dentist you can probably work out payment terms if it is too much to pay all at once.
posted by magnetsphere at 11:48 AM on August 7

Or you could be cynical and NOT tell your dentist so that s/he submits the request and both you and s/he will get the response from your insurance company. Which, in every case I have personally dealt with, included the negotiated payment amount. Could be useful as a negotiating tack.
posted by phearlez at 11:58 AM on August 7

If at all possible, try to find a dentist that caters to the uninsured (this is very common for dental work, not so common for doctors). I've had 2 fillings and when I went to a dentist who takes uninsured people, it was $70 including the x-rays, and when I went in an emergency situation to a regular dentist it was $350. No need to try and scam your dentist/insurance.. getting a filling is minor work that takes around ten minutes.
posted by shownomercy at 12:07 PM on August 7

You should get the insurance-negotiated rate. You will be a Delta Dental insuree - so the dentist will just submit the claim and it will be denied. They could lose their preferred provider status if they try to charge you more than the "maximum allowable cost." (that's insurance-speak).
posted by shrabster at 12:21 PM on August 7

Would Delta pay the dentist and then invoice me to reimburse them?

Nope, the dentist's office will submit the claim, Delta will deny the claim, and then the office will send you a bill. If the office knows the work isn't covered, they may ask you to pay up front, but you should be able to work out a payment plan if you can't pay it all at once. I can't say whether you'll be able to get the negotiated rate.

In some instances it can be useful for the office to submit the claim to the insurance company even if you know it's going to be denied. In my case, my program is set up so that any denied claims are reimbursed out of my flexible spending account (if there's funds remaining), without any additional paperwork on my part, so that's nice.
posted by DevilsAdvocate at 12:30 PM on August 7

Thanks for all of the responses.

The dentist is a really good guy, so I don't actually want to be a problem for him in re insurance claims and getting paid. Are claim denials de rigeur for dental practices, or is it a big deal for them to deal with?
posted by stewiethegreat at 1:23 PM on August 7

Your dentist's billing coordinator, the moment she confirms your insurance status online, will know you have a waiting period. She should then explain your out of pocket expenses to you, and you will likely be expected to pay those at the time of service.
Phearlez gives poor advice.
posted by OHenryPacey at 1:40 PM on August 7

Are claim denials de rigeur for dental practices, or is it a big deal for them to deal with?

I've never worked in insurance or medical billing, but I have had some out-of-pocket dental expenses this year, and I got the impression that they were completely ordinary. Of course, you should pay your bills on time; I'd imagine it's annoying if they have to send multiple invoices to get you to pay.
posted by DevilsAdvocate at 2:58 PM on August 7