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        New Message Board Archives >> 2007 General Board Posts >> Insurance restrictions MATTER
        
(Message started by: Redd715 on Feb 1^st, 2007, 7:52pm)

Title: Insurance restrictions MATTER
Post by Redd715 on Feb 1^st, 2007, 7:52pm

I admit, this isn't about prescritions, but I learned something today about insurance matters.

My dental insurance from Nov to Jan was covered with company A. Under this insurance my Dentist was not a "proferred provider". What I learned this meant, was that whatever charges above and beyond what insurance would cover, they could charge back to me.

Example.

Root Canal:
Dentist charges: $936

Insurance says they will cover 80% of customary charges of $760.

this means that they will pay: $608

Difference between customary and actual charges is $176. Then add the uncovered 20% of $152

They can and do make me pay this difference if they are not on the "profered provider" list.

Now...as of Jan 1 The new company who is taking over our dental insurance is covering at the same rates..however, my dentist is now in the "PP" list so they are required to write off that $176 balance. They cannot charge me for this.

So...

Change is good...thats my take on this... and I still have ALOT of dental work that needs to be done...But at least now I'm "in" network...and I'll be paying half of what I was before..

Now...I ask the math geniuses to please tell me if I'm missing something..

Title: Re: Insurance restrictions MATTER
Post by FramCire on Feb 1^st, 2007, 7:55pm

$152 oand/or some teeth?

Title: Re: Insurance restrictions MATTER
Post by Kevin_M on Feb 1^st, 2007, 8:05pm

Sounds good to me Redd. My dentist is out of network, or not PP but I like her. The savings makes a difference, go for it, get things taken care of and smile. ;)

Title: Re: Insurance restrictions MATTER
Post by Redd715 on Feb 1^st, 2007, 8:18pm

I'm sort of lucky I guess...my Dentist is also one of my Advertising clients. I'm saving this guy about $1500 over the course of a year...in advertising costs by getting him on contract. In return, I doubt he's going to do shoddy dental work for me...

He did a double root canal and I was back to work that same afternoon...I didn't feel a damn thing...

Then again we CH'ers have high pain threshholds.

Title: Re: Insurance restrictions MATTER
Post by Redd715 on Feb 1^st, 2007, 8:26pm

on 02/01/07 at 19:55:05, FramCire wrote:

$152 oand/or some teeth?

What I'm saying is that what I will pay in the future, could be almost half of what I paid in the past.
Granted they (the insurance Company) only got what...36 bucks in premiums out of me. I still came out ahead...

The point is, that now that the new carrier is in place, and the yearly maximum is the same, the write off's etc. give me more dental work for the same out of pocket costs yearly than the other coverage did.

Thats a good thing...right? Or am I not seeing this correctly?

Title: Re: Insurance restrictions MATTER
Post by Linda_Howell on Feb 1^st, 2007, 8:27pm

Root canal $936.00
Savings to him, for work you did $1,500.00

He owes YOU $ 564.00

Title: Re: Insurance restrictions MATTER
Post by Mosaicwench on Feb 1^st, 2007, 8:52pm

My dentist was on our "preferred" list until the insurance people wanted him to pump his patients for additional information that had nothing to do with dentistry.

He dropped from their preferred list and kept charging us as if he was still on it - which means he wrote off anything that wasn't paid for while "preferred".

Great guy! Been with him for 15 years.

Title: Re: Insurance restrictions MATTER
Post by Redd715 on Feb 1^st, 2007, 9:20pm

on 02/01/07 at 20:27:54, Linda_Howell wrote:

Root canal $936.00
Savings to him, for work you did $1,500.00

He owes YOU $ 564.00

We sign "conflict of interest" contracts.

Wish it was a tit for tat thing..

Not legal...

Title: Re: Insurance restrictions MATTER
Post by Linda_Howell on Feb 1^st, 2007, 9:56pm

Save him .12 cents then next year. lol

Title: Re: Insurance restrictions MATTER
Post by Woobie on Feb 2^nd, 2007, 9:08am

i hate dentists...
just talking (typing) about them makes my teeth hurt.

i will let my frikkin teeth fall out before i ever go to another dentist. ever again. in my life.

i dont care HOW much my insurance pays or what i gotta pay.............i aint going there.

unless............one condition

knock me out and do EVERYTHING at once... fillings, cleaning, root canals - pull em - i dont care.. if it's gotta be done - do it all at once and knock me the F*** out... cuz if you hurt me - or poke a nerve - you will get jacked. Not kidding.

my mother had periodontal disease - and my gums are now receeding - they wanna go in and scrap underneath them... >:(.... 'funny thing is - they want to do it to me TWICE. Once for the uppers - once for the lowers. I told him - knock me out and do it all at once..
he said no.

IF i can tolerate it once - i KNOW i wont come back for the second time... either do it all at once, while i'm sleeping - or no deal.

i will birth babies and pass kidney stones and cut my frikkin finger off - but dont mess with my TEETH. I will brush and floss and do my bestest to take care of them every single day - but i will NOT let no one scrap those little hooky things onto my highly sensitive teeth ... and poke them into my filings...........

you've gotta be one sick, sadistic, fucked up individual to wanna be a dentist when you grow up... >:(

and that is how i feel about dentists ;;D

woobs

Title: Re: Insurance restrictions MATTER
Post by Woobie on Feb 2^nd, 2007, 9:10am

Sorry Redd.........

but I feel much better now [smiley=laugh.gif]

Title: Re: Insurance restrictions MATTER
Post by Redd715 on Feb 2^nd, 2007, 9:12am

Don't be sorry Woobsie my friend. There are dentists who do just waht you are requesting. It's called sedation dentistry. Look into it. It's more expencive, but you won't remember a thing when it's over.

Title: Re: Insurance restrictions MATTER
Post by Wilbur on Feb 2^nd, 2007, 10:27am

Woobs - Put down the gun and back away slowly. :o

Some dentists actually go into dentistry because they want to help people like you keep their natural teeth for their entire lives. Look into the sedation thing.

Title: Re: Insurance restrictions MATTER
Post by Redd715 on Feb 2^nd, 2007, 11:04am

My dentist offers sedation. I don't need to use it though. He's also a cosmetic dentist.

Dentistry has come a long way in the last 10-12 years.

I used to hate dentists as well. In fact last March when I broke that one tooth, I went to a different guy for the temp fix, and I hated him. Bad additude, and bad manner.

I like my Dr. Koehl. He's the bestest.