How do I shop for dental services (NYC)?
October 18, 2014 1:36 PM   Subscribe

How do I determine whether the costs on my dental predetermination form are reasonable and/or shop around for a better deal?

I visited a dentist a few weeks ago to do the regular check-up (cleaning, x-rays). I knew beforehand that I need (the remaining) two wisdom teeth out, and the dentist also recommended that I get one smallish cavity filled.

A few days ago, I received a predetermination form for these services from my dental insurance company. (This is an employer sponsored plan and the dentist is in-network.) For each wisdom tooth, it quotes a fee of $500, with an allowance of $218. For the filling, the corresponding numbers are $250 and $72. My interpretation here is that I'd need to pay the difference between the fee and the allowance, i.e., $282 for each wisdom tooth and $178 for the filling (the allowances sum to the total of covered charges, which are explicitly covered "@ 100%").

How do I determine if these fees are reasonable? When I entered the procedure numbers on this website, I was returned total fees of $695 and $325 respectively. In light of this, I suppose these quotes seem reasonable enough...? However, I'm not sure if there is usually spread in pricing across dental providers and whether it would be worth shopping around for a better deal.

If I were to "shop around", how would I do this in practice? I don't really see dental office posting fee schedules on their websites. Could I call a dentist's office and ask how much their fee is for procedure number D7220? Or would I need to go to become a customer with them and get another predetermination before they'd actually tell me their fees?

Finally, should I interpret the fee as the actual price or as a sticker price that may be open for bargaining/negotiation (similar to non-dentistry medical services)?

Thank you so much!
posted by yonglin to Health & Fitness (4 answers total)
Both of my kids have wisdom teeth out in the last 5 year's and I'm pretty sure retail on both procedures was over $2000, so your prices seem fine.
posted by COD at 1:52 PM on October 18, 2014

250 retail for a filling seems high to me, as someone who has had a lot of fillings in her lifetime. What does your insurance plan say about coverage for these procedures?

This is how mine works: if the dentist is in-network, then they've agreed to limit their fee to what the insurance company deems reasonable. The insurance then agrees to cover usually 80% of that pre-negotiated fee, and you pay the other 20%. I don't have any knowledge or experience of the model that you appear to have, where the insurance company pays 100% up to a pre-set amount but even in-network dentists will charge far above that amount.
posted by serelliya at 2:46 PM on October 18, 2014

In answer to your question about how do you shop around, I have definitely called up dentists and told them what my current dentist was recommending and asked how much they would charge for that same service. I had a bad experience during a regular cleaning, which was my first time seeing a new dentist -- I believed her that I needed a filling but there was no way I was going back to that dentist for any procedure. So anyway, I called to some dentists that friends recommended and asked for an estimate. I told them which tooth and they gave me a range, from "small cavity" to "large cavity" and then the real price fell in between. I didn't get the impression it was that weird a thing to do. I also did this when I needed a wisdom tooth out and had no insurance; that ended up being a straight quote $800/tooth w/anesthesia (in a different market from you).
posted by Tandem Affinity at 6:35 PM on October 18, 2014

The wisdom teeth prices seem OK but $250 for a "smallish filling" seems high. However, it's not the size of the filling but the number of surfaces that usually goes into pricing. There are several AskMe questions about NYC dentists you can look through. I chose my dentist that way (though I'm withholding recommendation due to staff changes.)
posted by Obscure Reference at 8:10 AM on October 19, 2014

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