February 8, 2010 8:04 AM   Subscribe

Does what my dentist's receptionist told me re: dental insurance and my deductible make sense?

I just got my teeth cleaned, and my dentist wants to do a couple of preventative fillings and replace a bigger, old filling. The receptionist told me how much this should cost (~$75 if I go with silver for the big filling, ~$150 if I go with white) and then said something that really confused me: because my insurance deductible is $50, they're going to charge me an additional $50 on top of the price of my fillings.

Does that make sense? I always thought that the whole point of a deductible is that I don't pay anything beyond it (and that in this case, my insurance should be covering anything over $50). I was like, "Whaaat?" to the receptionist, and all she could say is, "That's what the insurance company tells us to say."

This is my first dental insurance plan, so I fully accept the possibility that I might be wrong about this, but is this the way dental insurance works? Are dental deductibles really an additional charge on top of the price of the service? If it matters, I have Delta Dental Premier coverage in Massachusetts.
posted by oinopaponton to Health & Fitness (12 answers total)
I've had dental insurance before, and medical insurance that had a deductible, and I've never heard of such a thing. The deductible isn't supposed to have anything to do with the cost of the care you get, it's just supposed to be the minimum amount you're responsible for paying.

Really, the dentist's office shouldn't care about the deductible. They should just bill your insurance, and your insurance should bill you for however much you owe.
posted by cerebus19 at 8:09 AM on February 8, 2010

That doesn't make any sense. If they press you on the issue, tell them you'll just pay for the full cost of services and bill your dental insurance yourself.
posted by something something at 8:11 AM on February 8, 2010

Yeah. That makes no sense.

Deductible works as you probably think it does:

Your filling costs $150 - you pay $50, and your insurance pays the rest. Dental insurance is not qualitatively different than any other kind of insurance in that respect. It's very very possible that the receptionist has no clue what she is talking about. Receptionists generally don't deal with billing, so someone may have told her something which she got a little confused. I would take it up with their billing dept. directly.
posted by orville sash at 8:17 AM on February 8, 2010

I don't know whether the receptionist is trying to do something wrong, or simply explaining things badly. As written, it doesn't make much sense.

That said, your conception of what a deductible is isn't quite right either. If you have a $50 deductible, then you pay the first $50 of the cost. The insurance applies to whatever expenses exceed $50, but may not pay for all of it. If you have good insurance and the dentist has an agreement with your insurance company, then it may very well cover all remaining costs, paid at some pre-negotiated discount. If you have lousy insurance or the dentist is out-of-network, then you may be on the hook for additional costs, i.e. a percentage of the remainder. For example, if you had a 80%/20% insurance and a $50 deductible, and had a $400 service done, you'd have to pay 50+(350*0.2)=$120.

In any case, the deductible is NOT an amount that's added to the overall bill.
posted by jon1270 at 8:17 AM on February 8, 2010

Best answer: Yes, this makes sense. I also have Delta Dental in MA, and this is how it works.

You get your teeth done. The total for the fillings is, say $400. You have a $20 copay for the visit. The fillings cost you out of pocket, say $150 because you're going with the white resin rather than the metallic.

In addition, Delta Dental charges a $XX/year deductible for services. I think mine is actually like $100 or something (I don't think I have a great plan). So, once a year, you have to pay an additional $100 of your bill (beyond the copay and your share of services). If your payment is made in the fourth quarter of the year, it will also serve as your full payment for the following year.

So, in this circumstance, you would pay your copay, the cost of your services, plus the deductible.
posted by Admiral Haddock at 8:18 AM on February 8, 2010

Best answer: And to clarify this, the amount you are being told is the cost ($150 for the epoxy) is NOT the cost to the insurer--they're paying $400. In this scenario, your $50 deductible is not being added to the total bill, it's just being added to YOUR bill (and subtracted from the insurer's bill).
posted by Admiral Haddock at 8:21 AM on February 8, 2010 [1 favorite]

Response by poster: Thanks, Admiral Haddock. That makes much more sense. Sucks, but I guess it's better than paying for it all OOP.
posted by oinopaponton at 8:23 AM on February 8, 2010

It sounds like your insurance only covers up to $100 for fillings. So, in this case, if you wanted the white ones, you'd have to pay the difference?
posted by ijaaz at 8:24 AM on February 8, 2010

Best answer: Yeah, I think you're just misunderstanding her explanation.

It usually works like this: The patient is potentially responsible for paying up to three parts of any particular dentist bill:

(1) The office visit copay ($10-$20 usually - on my dental plan there is no copay for office visits)
(2) Some percentage of the cost of any particular procedure (in your case, you may pay 0% of the cost of getting an examination or x-rays, but pay 20% of the cost of getting fillings, while the insurance company pays the rest)
(3) A yearly deductible.

So what the receptionist is trying to say is that your share of the cost of getting fillings is $75 or $150. The insurance company is going to cover the rest of the cost. However, you haven't paid your yearly deductible yet, so you have to add on the first $50 of what the insurance would normally pay to your bill. They're (hopefully) not making their procedure "more expensive" in total, but your share of the cost is slightly more expensive.

Really, the dentist's office shouldn't care about the deductible. They should just bill your insurance, and your insurance should bill you for however much you owe.

In some cases, the dentist's office will collect their share of the payment based on what they believe your insurance will cover, and then charge the insurance for the rest. At least, that's how my dentist office works - I get a procedure done, write a check for my share, and then receive a statement in the mail from my insurance company stating that they paid their part.
posted by muddgirl at 8:27 AM on February 8, 2010

Here's the missing link with dental insurance - what they call "reasonable and customary charges," aka "the biggest crock of bs in the history of insurance".

There are the charges that your insurance THINKS you should be charged, based on a bunch of bullpucky, mostly some average of what dentists in your area charge, and that is what they will pay. Then, there is what your dentist actually charges.

There is often a large difference between those two numbers.

The problem is that your dental insurance will not just give you a worksheet listing what they will pay for certain procedures. You can fight this by requiring your dentist to get every treatment approved in advance and giving you the numbers of what you will be responsible for BEFORE you have the treatment. If they won't do it, you can get their quotes for the procedures and call your dental insurance yourself. Then, send a letter to your dentist saying "for this procedure you quoted me X, my insurance says they will cover Y, so I will owe Z, unless there some kind of non-standard complications".

Dentists don't like doing this and some will outright refuse. Those are the con artists, stay away. Some dentists will just charge the 'reasonable and customary'. Others charge a little more than reasonable and customary but not a ton. IMHO, a fair dentist will be completely open about pricing and that's one you should work with. It will usually take time to find someone like that. I finally got my dentist to agree to charges in writing, only for them to email me later and basically say, "I was in a hurry to leave the day you asked six times if there would be any other charges and didn't tell you there would be these six other charges, the price is actually X". So now I'm looking for another dentist.
posted by micawber at 10:00 AM on February 8, 2010 [2 favorites]

Get a second opinion about whether or not those fillings need to be replaced. I got suckered out of money that way and of turned out they didn't need replacing.
posted by anniecat at 11:24 AM on February 8, 2010

Response by poster: anniecat-- I'm really stingy, but in this case I think I'm going to let them do it... the dentist went into my mouth with a mirror to show me what's going on (she thinks some of the epoxy on the old filling broke off; in any case, there's some visible nastiness going on there). The preventative coating ones I could probably live without, but who knows if I'll have dental insurance this time next year. $200-ish isn't that bad in the long run, especially when it comes to my teeths.

Thanks again for explaining this, everybody. You spared me what would probably have been a bunch of frustrating, circular conversations with my insurance company.
posted by oinopaponton at 11:32 AM on February 8, 2010

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