Dental protocol on "free" cleaning
April 22, 2019 7:51 AM Subscribe
My dental insurance offers two free cleanings a year; but is that "free" like beer, or "free" like loss leader, and how do I keep it free?
As with many people, I haven't been to a dentist in quite some time. First, it was being without insurance, but I've gotten good Delta dental insurance with my current employer, but I haven't partaken in the two free cleanings covered a year yet because in the past, they've never been free -- "oh, new patients always need xrays taken", "didn't the technician tell you {offhandedly offered treatment} costs $$/isn't covered? Sorry", "we found a few cavities, I can get you in Thursday".
So, free cleanings in the past have always cost hundreds of dollars, and I don't have a budget for that yet. It's been an 'out of sight, out of mind' -- I don't have any obvious teeth problems -- but I'm trying to be mindful of being an adult and taking care of grown up responsibilities and this is one of the items on the list.
Is it bad form to insist to a dentist that the free cleaning stays free, and figure out the expensive stuff later? Or any tips on how to negotiate the free cleaning for what it is or to keep price to a minimum? Or is that just the way it is, TINSTAAFDC (There Is No Such Thing As A Free Dental Cleaning)?
As with many people, I haven't been to a dentist in quite some time. First, it was being without insurance, but I've gotten good Delta dental insurance with my current employer, but I haven't partaken in the two free cleanings covered a year yet because in the past, they've never been free -- "oh, new patients always need xrays taken", "didn't the technician tell you {offhandedly offered treatment} costs $$/isn't covered? Sorry", "we found a few cavities, I can get you in Thursday".
So, free cleanings in the past have always cost hundreds of dollars, and I don't have a budget for that yet. It's been an 'out of sight, out of mind' -- I don't have any obvious teeth problems -- but I'm trying to be mindful of being an adult and taking care of grown up responsibilities and this is one of the items on the list.
Is it bad form to insist to a dentist that the free cleaning stays free, and figure out the expensive stuff later? Or any tips on how to negotiate the free cleaning for what it is or to keep price to a minimum? Or is that just the way it is, TINSTAAFDC (There Is No Such Thing As A Free Dental Cleaning)?
Best answer: My insurance covers one free set of xrays a year. Find out what your insurance covers from the insurance company or your policy paperwork. Then, I'd discuss this with whomever you make the appointment with and make it clear you're only authorizing the routine free exam and cleaning. Reiterate when you are at the appointment.
posted by quince at 8:01 AM on April 22, 2019 [5 favorites]
posted by quince at 8:01 AM on April 22, 2019 [5 favorites]
Best answer: I've found in recent years that all of the dentists I've been to have been scrupulous about checking insurance coverage on recommended preventative things that may or may not cost (x-rays, fluoride, etc.) and telling me up-front what my out of pocket would be. If your dentist doesn't explicitly tell you what your out-of-pocket will be, then it's fine to ask. Usually x-rays are covered and fluoride [for adults] isn't, but I've had dental insurance that covers the latter as well. Anything else that isn't preventative (cavities, etc.) generally involves some out-of-pocket but they'll give an estimate before moving forward (and again, if they don't - ask!)
I also wouldn't use the word "free" - the dentist is still getting paid for it, after all, so that might confuse things - it's "fully covered" or "no deductible" or "no out-of-pocket" that you're looking for. "I don't have budget for anything that isn't fully covered by my insurance so can you let me know if anything will incur an out-of-pocket cost?" is perfectly fine to say.
posted by mosst at 8:11 AM on April 22, 2019 [20 favorites]
I also wouldn't use the word "free" - the dentist is still getting paid for it, after all, so that might confuse things - it's "fully covered" or "no deductible" or "no out-of-pocket" that you're looking for. "I don't have budget for anything that isn't fully covered by my insurance so can you let me know if anything will incur an out-of-pocket cost?" is perfectly fine to say.
posted by mosst at 8:11 AM on April 22, 2019 [20 favorites]
Best answer: I think it's good to be wary. A friend of mine is a hygenist and has tales of dentists who "work the system" to make money off procedures that aren't strictly necessary.
For example, one dentist would review a patient's teeth and tell the hygenist the tooth number as they went along. The hygenist was to repeat back how recently that tooth was filled. That's because insurance would only cover replacing the filling if it was at least two years old. My friend asserted that the dentist also intentionally made fillings more shallow than necessary so that they wouldn't last as long.
The following is very IANYD:
I asked that same friend for advice b/c I was dealing with a dentist who seemed to be "drilling for oil": putting in fillings where they weren't necessary. My friend said: "If they recommend a filling, make sure that the explorer sticks in a cavity when they're probing it. If you didn't feel it stick and they couldn't demonstrate it sticking, ask them to show it to you on an x-ray. If they can't do either, get a second opinion."
I also Nth the above suggestions to call and ask for a breakdown for all fees for the visit. If x-rays aren't covered, can you skip them? Can you forward them your x-rays from your previous dentist? Are the the cleanings "free" because your insurance makes them free, or are they a loss-leader? These are all reasonable questions to ask.
posted by homodachi at 8:12 AM on April 22, 2019 [2 favorites]
For example, one dentist would review a patient's teeth and tell the hygenist the tooth number as they went along. The hygenist was to repeat back how recently that tooth was filled. That's because insurance would only cover replacing the filling if it was at least two years old. My friend asserted that the dentist also intentionally made fillings more shallow than necessary so that they wouldn't last as long.
The following is very IANYD:
I asked that same friend for advice b/c I was dealing with a dentist who seemed to be "drilling for oil": putting in fillings where they weren't necessary. My friend said: "If they recommend a filling, make sure that the explorer sticks in a cavity when they're probing it. If you didn't feel it stick and they couldn't demonstrate it sticking, ask them to show it to you on an x-ray. If they can't do either, get a second opinion."
I also Nth the above suggestions to call and ask for a breakdown for all fees for the visit. If x-rays aren't covered, can you skip them? Can you forward them your x-rays from your previous dentist? Are the the cleanings "free" because your insurance makes them free, or are they a loss-leader? These are all reasonable questions to ask.
posted by homodachi at 8:12 AM on April 22, 2019 [2 favorites]
Best answer: You can decline the x-rays. You can also decline having cavities filled, although that's going to cost you a lot more if you wait rather than taking care of it immediately.
One thing to consider - my dentist takes my insurance, but they are out of network and they require payment up front. This means I have to pay for everything when I'm there and then a few weeks later I get a reimbursement check in the mail from my insurance company, which, due to the dentist's out of network status, doesn't cover even the twice-yearly cleaning at 100%. I end up paying an extra $20 or something out of my own pocket.
It's OK to ask a dentist's office questions about how they handle billing and insurance filing before you make an appointment.
posted by something something at 8:16 AM on April 22, 2019
One thing to consider - my dentist takes my insurance, but they are out of network and they require payment up front. This means I have to pay for everything when I'm there and then a few weeks later I get a reimbursement check in the mail from my insurance company, which, due to the dentist's out of network status, doesn't cover even the twice-yearly cleaning at 100%. I end up paying an extra $20 or something out of my own pocket.
It's OK to ask a dentist's office questions about how they handle billing and insurance filing before you make an appointment.
posted by something something at 8:16 AM on April 22, 2019
Best answer: The only things dentists (And I've been to plenty) have ever tried to "upsell" me on during my visits has been getting cavities filled, but they've always shown me the cavities on x-rays. I've used those x-rays to get a second opinion just to be sure sometimes, such as in the case of a wisdom tooth, where getting them out immediately isn't always strictly necesssary, or when I questioned the offer of a non-oral surgeon dentist to extract my wisdom teeth for me.
posted by shaademaan at 8:18 AM on April 22, 2019 [1 favorite]
posted by shaademaan at 8:18 AM on April 22, 2019 [1 favorite]
Best answer: Yes, think of these as COVERED cleanings, not free cleanings. You (or your employer) are paying for them as part of your premium. The dental insurance is then covering them.
I feel for you, as someone with bad teeth.
posted by fiercecupcake at 8:25 AM on April 22, 2019 [6 favorites]
I feel for you, as someone with bad teeth.
posted by fiercecupcake at 8:25 AM on April 22, 2019 [6 favorites]
If you don't have dental problems, you probably only need a cleaning every year to 18 months. Agreed that you should be cautious of a new dental provider recommending unnecessary procedures.
My experience with dental insurance is that cleanings will be either free or a small copay and include x-rays (you probably don't need xrays every year if you don't have known dental problems, but a set when starting with a new provider is typical). But ask! It sounds like you have insurance with a dental practice chain, so asking coworkers what to expect is an option.
posted by momus_window at 8:37 AM on April 22, 2019
My experience with dental insurance is that cleanings will be either free or a small copay and include x-rays (you probably don't need xrays every year if you don't have known dental problems, but a set when starting with a new provider is typical). But ask! It sounds like you have insurance with a dental practice chain, so asking coworkers what to expect is an option.
posted by momus_window at 8:37 AM on April 22, 2019
Yes, check with your company or your insurance policy and see what your coverage is. My (absurdly good) corporate dental insurance covers cleanings twice per year, standard xrays once per year, a complete suite of xrays once per 5 years, and covers cavities/fillings/root canals at 100%, and a bunch of more complex procedures at 70-90%. Since the cleaning is so much cheaper than a bunch of fillings or worse, it's in their interest that I get the cleanings to generally keep everything healthy, rather than wait until I have a very expensive problem. That's why they cover them at 100%.
Everyone else has good advice about working with the dentist's office to verify that they'll get your permission before performing any non-covered procedures.
posted by yuwtze at 8:40 AM on April 22, 2019 [2 favorites]
Everyone else has good advice about working with the dentist's office to verify that they'll get your permission before performing any non-covered procedures.
posted by yuwtze at 8:40 AM on April 22, 2019 [2 favorites]
Best answer: And do ask around your friends and coworkers for their favorite dentist! I kind of reflexively avoid the mass-consumer dentists because I feel like they'll upsell but just see who people recommend and ask them how long they have been seeing them. You can even mention that you hate getting "upsold" on things and see what they say. My very longtime dentist who I love and the longtime hygienist who I really, really love have started having more items in their "store" and procedures and things that they are selling. But, I just say, "no, thanks" and that's the end of it. They were offering a not-covered, adult fluoride treatment last time and I just declined. You can decline anything! But for a typical cleaning, even after a long period of no dentist visits, I think you'll likely be fine. For some reason, my dental cleanings are not fully covered by my insurance. I always owe $4. Seems worth it to me.
posted by amanda at 8:43 AM on April 22, 2019 [3 favorites]
posted by amanda at 8:43 AM on April 22, 2019 [3 favorites]
(And it will be in both your and the dentist's best interests for you to also have an idea what your coverage is, since each patient has a different policy, and they'll have to look up your specific policy's coverage. If your policy doesn't cover something that most other policies do, they may not think to check on your behalf unless you ask them.)
posted by yuwtze at 8:45 AM on April 22, 2019
posted by yuwtze at 8:45 AM on April 22, 2019
A dentist friend went from private practice to working for a company in semi-retirement and found himself pressured to upsell. He advised us to get second opinions if we ever had a big change in the amount of work he needed. The Atlantic just published an article on the problem of gratuitous procedures in dentistry. So you are right to be cautious.
That said, dentistry is the sort of thing that costs way more if you wait to have work done. Today's cavity is tomorrow's root canal, crown, or implant, and you could end up paying thousands of dollars, even with insurance, for something that could have been fixed earlier for a few hundred.
posted by FencingGal at 8:51 AM on April 22, 2019 [5 favorites]
That said, dentistry is the sort of thing that costs way more if you wait to have work done. Today's cavity is tomorrow's root canal, crown, or implant, and you could end up paying thousands of dollars, even with insurance, for something that could have been fixed earlier for a few hundred.
posted by FencingGal at 8:51 AM on April 22, 2019 [5 favorites]
I have Delta insurance, and can confirm that they cover two check-ups, and one set of x-rays, per year, up to a certain amount of money. It's not free, but you or your employer have already paid for this, so it makes sense to use it.
posted by ubiquity at 9:16 AM on April 22, 2019 [2 favorites]
posted by ubiquity at 9:16 AM on April 22, 2019 [2 favorites]
Best answer: The insurance company is covering two cleanings per year as preventative care. This is reasonable, because preventative care is cheaper than restorative care, just as a general rule. So it makes sense that they'd do this.
However, the reimbursement rates to dental offices for these cleanings aren't super-high. IMO it's still enough that they should be fine (I think the rack rate at my local place is $95, and it doesn't take more than an hour, and $95/hr seems not unreasonable for skilled labor and use of the office), but there are offices that aggressively upsell and seem to have built their entire business model around adding on stuff to the reimbursed cleaning fees.
I'd definitely get the cleanings done—they're legitimate preventative measures, and a lot more pleasant than a root canal—but I'd tell both the receptionist and the hygenist who actually does the cleaning that you're not up for anything that has a co-pay or isn't covered 100% by your insurance. That may mean no fluoride treatment, maybe no X-rays, but shouldn't be an issue with the basic cleaning. If they balk or can't promise that they'll stay within just the insurance-covered scope of treatment without letting you know first, find a different dentist.
posted by Kadin2048 at 10:47 AM on April 22, 2019 [3 favorites]
However, the reimbursement rates to dental offices for these cleanings aren't super-high. IMO it's still enough that they should be fine (I think the rack rate at my local place is $95, and it doesn't take more than an hour, and $95/hr seems not unreasonable for skilled labor and use of the office), but there are offices that aggressively upsell and seem to have built their entire business model around adding on stuff to the reimbursed cleaning fees.
I'd definitely get the cleanings done—they're legitimate preventative measures, and a lot more pleasant than a root canal—but I'd tell both the receptionist and the hygenist who actually does the cleaning that you're not up for anything that has a co-pay or isn't covered 100% by your insurance. That may mean no fluoride treatment, maybe no X-rays, but shouldn't be an issue with the basic cleaning. If they balk or can't promise that they'll stay within just the insurance-covered scope of treatment without letting you know first, find a different dentist.
posted by Kadin2048 at 10:47 AM on April 22, 2019 [3 favorites]
Best answer: "Cleaning" is only a layman's term, not an actual dental procedure. A routine prophylaxis is the superficial "cleaning" and polish that long-standing healthy patients with no periodontal inflammation get. and most kids.
In order to establish yourself at an office where you've never been seen, or haven't been having regular preventive care, expect to have a comprehensive exam that should include periodontal (pocket depth) charting and some x-rays. That exam will establish whether you require treatment of disease, or simply "a cleaning".
You can always decline treatment once the exam is complete, but an ethical dentist wouldn't "just clean" your teeth if you have an underlying periodontal disease for some very compelling reasons.
I have many patients who pay nothing out of pocket for their bi-annual visit, but it's not something we negotiate, they're either healthy enough to qualify for their insurance benefit or they aren't.
posted by OHenryPacey at 4:12 PM on April 22, 2019 [4 favorites]
In order to establish yourself at an office where you've never been seen, or haven't been having regular preventive care, expect to have a comprehensive exam that should include periodontal (pocket depth) charting and some x-rays. That exam will establish whether you require treatment of disease, or simply "a cleaning".
You can always decline treatment once the exam is complete, but an ethical dentist wouldn't "just clean" your teeth if you have an underlying periodontal disease for some very compelling reasons.
I have many patients who pay nothing out of pocket for their bi-annual visit, but it's not something we negotiate, they're either healthy enough to qualify for their insurance benefit or they aren't.
posted by OHenryPacey at 4:12 PM on April 22, 2019 [4 favorites]
It's a great idea to go see someone who someone else you know is seeing as their dentist too. I had vague suspicions for years that my dentist "must be making up" cavities. But then my partner started to see the same dentist and he's never had a single filling recommended there, and I feel much better about the dentist now that I know that. Still sucks to know that he can get away with flossing every other day and occasionally skipping brushing, and I get a bunch of cavities unless I'm super diligent, but at least I have more confidence that they're real.
posted by Lady Li at 6:20 PM on April 22, 2019
posted by Lady Li at 6:20 PM on April 22, 2019
I have been to three different types of dentists:
1. My current dentist, a regular practice in the downtown of a small suburb, fairly comparable to the family dentists my parents took me to when I was a kid
2. While I was in grad school I went to a dental school at my university - this was very cheap, very slow (half-day appointments!), but involved a lot of information about everything they saw in my teeth. I got to hear a student explain to a professor what they saw, the professor take a look and comment on it, discuss options, etc. Because of this I feel like I understand what's going on at my regular appointments better.
3. That one time when I was new in town and just needed to get a weird tooth thing checked out, and I went to a strip mall dental franchise/chain "$57 New Patient Offer" kind of thing. I could name names, but you know which G.D. I mean.
I had a really mediocre experience at the strip mall. They didn't seem to do a bad job, but the filling they did needed to be replaced after a year or two, and when I got a new individual-practice dentist, the first thing they did was take new x-rays (which I had to pay for because I'd had xrays at G.D. recently) because the strip mall x-rays were lower resolution on film, and a lot of modern practices do digital imagery with more detail. The thing that would really matter to you is that the mood seemed really different at the two practices, the franchise people were all about getting you in the door and getting you into their system, and of course offering you treatments. The suburban practice seemed to mostly deal with people with money (they often offer me extras I really don't give a crap about, like whitening), they've got really high-end equipment, keep excellent digital records with several different types of images (fiber optic cameras, digital x-rays, 3d scan of drilled tooth to custom-machine a crown) but at the same time they deal really well with individuals. When I've said "ok my insurance will pay for X but not Y" they say "ok, let's do X then, and we'll revisit Y in the new year, by the way this fluoride may help here's a sample bottle and a prescription if you decide to fill it".
So my advice: find a genuinely good dental practice that has all the equipment to do things thoroughly and right and isn't trying to bring new patients in by promising low first-visit prices. Explain to them what you need: you need a cleaning and an exam, you want to know what's going on in your mouth, but you want to not take any actions today, in fact you'd like a prioritized list of all the things they'd recommend and associated costs, and anything they know about your insurance provider, and you'll discuss it at your next regularly scheduled visit 6 months from the first.
posted by aimedwander at 10:54 AM on April 23, 2019
1. My current dentist, a regular practice in the downtown of a small suburb, fairly comparable to the family dentists my parents took me to when I was a kid
2. While I was in grad school I went to a dental school at my university - this was very cheap, very slow (half-day appointments!), but involved a lot of information about everything they saw in my teeth. I got to hear a student explain to a professor what they saw, the professor take a look and comment on it, discuss options, etc. Because of this I feel like I understand what's going on at my regular appointments better.
3. That one time when I was new in town and just needed to get a weird tooth thing checked out, and I went to a strip mall dental franchise/chain "$57 New Patient Offer" kind of thing. I could name names, but you know which G.D. I mean.
I had a really mediocre experience at the strip mall. They didn't seem to do a bad job, but the filling they did needed to be replaced after a year or two, and when I got a new individual-practice dentist, the first thing they did was take new x-rays (which I had to pay for because I'd had xrays at G.D. recently) because the strip mall x-rays were lower resolution on film, and a lot of modern practices do digital imagery with more detail. The thing that would really matter to you is that the mood seemed really different at the two practices, the franchise people were all about getting you in the door and getting you into their system, and of course offering you treatments. The suburban practice seemed to mostly deal with people with money (they often offer me extras I really don't give a crap about, like whitening), they've got really high-end equipment, keep excellent digital records with several different types of images (fiber optic cameras, digital x-rays, 3d scan of drilled tooth to custom-machine a crown) but at the same time they deal really well with individuals. When I've said "ok my insurance will pay for X but not Y" they say "ok, let's do X then, and we'll revisit Y in the new year, by the way this fluoride may help here's a sample bottle and a prescription if you decide to fill it".
So my advice: find a genuinely good dental practice that has all the equipment to do things thoroughly and right and isn't trying to bring new patients in by promising low first-visit prices. Explain to them what you need: you need a cleaning and an exam, you want to know what's going on in your mouth, but you want to not take any actions today, in fact you'd like a prioritized list of all the things they'd recommend and associated costs, and anything they know about your insurance provider, and you'll discuss it at your next regularly scheduled visit 6 months from the first.
posted by aimedwander at 10:54 AM on April 23, 2019
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If you're worried about demands for xrays etc, call the office you intend to use, establish that the insurance coverage is 100% for a cleaning (i.e. find out exactly how much they charge and that they're in-network for you; you may have to call the insurance company to find out exactly what the coverage is) and tell them you don't have a budget for xrays, only the covered cleaning, and will they do the cleaning anyway. As far as cavities etc, I mean, they can't force you to have them filled, although it's a very bad idea not to.
[edit - agree your insurance probably covers occasional xrays too for the same reason.]
posted by fingersandtoes at 7:59 AM on April 22, 2019 [22 favorites]