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With dental insurance, the waters get a bit muddied, but there's just no way the TOTAL cost is $5500.
I find this unbelievable, too, but that's what 100% comes to if 20% is $1,100...
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If the insurance info you're giving me is correct, then you should be paying $220 out of pocket, with the insurance picking up $880, for a total of $1100.
Well, I said I specifically asked and also there's no way for a root canal to cost $220 out of pocket now when it cost me $400 10 years ago.
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My advice would be to clarify with the dental office. We could speculate as much as we want, but it won't get you much closer to the truth. Another way you can get a clearer, though not guaranteed, picture is to ask the office to submit a pre-authorization form. The insurance will send back a form that outlines the approved cost and your co-pay. It takes about 1 month though, and the endodontist's office probably will not be happy to do it.
BTW, Delta Dental has tens of millions of subscribers. It's known just about everywhere.
Thank you for the idea. I'll definitely shop around and consider other options, pain permitting... The antibiotic might take care of it, too. Had it been in summer, I would've gone back to my home country to see my relatives and make a trip out of this at least, for cryin' out loud. The plane ticket would cost about as much and the root canal itself - close to nothing... I might go down to Mexico if I find good recommendation. There are dozens of dentist offices by the border because they're well aware of the state of affairs here.
This sounds wrong... I just paid $400 for a root canal on a molar, and my insurance picked up 60%. Does your price include the crown that you have to get afterward to reconstruct the tooth? I had to pay the entire cost of the crown on my tooth, because the dentist tried to be conservative at first with an onlay. I still had sensitivity in that tooth, so the root canal was next. Luckily, my dentist only made me pay the $400 lab fee for the gold and porcelain crown. $800... That's where my "tax stimulus" payment went!
I had a root canal on a molar in April, and I paid about $300 out of pocket, and I don't have stellar dental insurance. The crown which was put on later was another $200 out of pocket.
This sounds wrong... I just paid $400 for a root canal on a molar, and my insurance picked up 60%. Does your price include the crown that you have to get afterward to reconstruct the tooth? I had to pay the entire cost of the crown on my tooth, because the dentist tried to be conservative at first with an onlay. I still had sensitivity in that tooth, so the root canal was next. Luckily, my dentist only made me pay the $400 lab fee for the gold and porcelain crown. $800... That's where my "tax stimulus" payment went!
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Originally Posted by Flashbaak
I had a root canal on a molar in April, and I paid about $300 out of pocket, and I don't have stellar dental insurance. The crown which was put on later was another $200 out of pocket.
Guess my quote doesn't sound right, but anything's possible according to this site:
It's not clear if they talk about total or out-of-pocket cost, though.
Actually, I didn't ask them about something else that needs to be done that might further complicate things. I have a bridge there and the referring dentist said they could do the root canal through the bridge keeping the bridge intact. If course, they can also break the bridge, which would be a source of additional "fun"!
The first dentist (I got 2nd opinion) suggested onlay, but it looks like the cost will be about the same because the insurance picks up only 50% of the onlay as opposed to 80% of the root canal. He quoted me $625 for that + another about $500 sort of a secondary charge they weren't quite sure whether the insurance will pay for or not ... Guess they were debating between whether it's covered at 80% or 50%. Later I found out the onlay is covered at 50%. Not sure if the onlay is better or not... as Sandy says later you may need the root canal anyway on top of that.
I was just at the dentist for a cleaning. I've been having sensitivity issues on a molar. I was told root canal is the only fix. $750 before insurance I was quoted. I believe that includes the crown. We also have Delta, but ours covers 50% not 80.
I just had a root canal a couple of weeks ago. My portion of the payment was about $800 and insurance picked up about $700. So the total cost was $1,500.
But that doesn't include the cap. To crown the tooth is going to be another $1000, I pay half. But I don't have the money for it right now so it will just have to wait.....
Most dental insurance is pretty bare coverage. They pay for fillings and cleanings but anything more complex than that and your percentage of the payment goes up up up. Honestly though, right now I'm grateful to have any kind of dental insurance.
There's a lot of price quotes being thrown around, without the proper context. I'm going to try to explain insurance. Hopefully it will help, but more likely it will confuse the heck out of people. First a disclaimer: this is a general guide. It will not specifically apply to your insurance plan because I don't know the specifics of your plan. Call your insurance co for details.
If you obtained dental insurance through your employer, more than likely the employer selected a dental plan for coverage. Contrary to what most people think, dental plans vary greatly in terms of: fees, coverage, inclusions and exclusions, waiting periods, plan maximums, etc.
First you need to identify what type of plan you have. There's PPO, DMO, and one other type that I don't know the name of. DMO=dental maintenance organization. That means you're committed to going to dentists enrolled in the DMO. PPO=preferred provider organization. That means if you go to a dentist enrolled in the DMO you'll get more coverage and set fees. If you choose to go to an "out-of-network" dentist, the insurance co will provide less coverage, but typically not that much (~10% on average). The third type doesn't have a network of dentists and allows you to go anywhere you want.
From the dentist's perspective, they can either be in-network or out-of-network. In network dentists sign an agreement with the insurance co to "play" by a set of insurance rules outlined. Out-of-network dentists do not sign such a contract and thus are free to set their own rules. A dentist is not required to accept insurance just because you have it, if they are out-of-network.
Plan maximum: Your insurance usually has a maximum dollar amount that the insurance company will pay on your behalf per year. Remember that this does not include your copay portion. Typical amounts are $1000 or $1500.
Coverage percentages: Coverages vary by plan and by procedure. A typical plan will cover exam, x-rays, and light cleaning at 100%, fillings and root canals at 80%, and crowns, bridges, and dentures at 50%.
Fees: In a HMO or PPO, the fees are set by region. So in-network dentists in the same area will be charging the same rate. Endodontists (specialists) are not constrained by the set fee. I'm not exactly sure how it works with specialists, but I *think* they're supposed to offer a discount of 25%. Don't quote me on that.
Exclusions: Implants are not typically covered. I don't know why, because implants are quickly becoming the standard of care for missing teeth. Sometimes bridges and dentures will not be covered as well, due to something called a "missing tooth clause". Ask your insurance co if you're subject to that, as it's a bit hard to explain.
Waiting period: A required period of time before the insurance company will start paying out benefits.
Ok, with the major definitions out of the way, let's examine why person A can pay more than person B. Suppose person A's insurance plan provides 50% coverage and sets the fee for root canal at $1000. Person B's insurance plan provies for 80% coverage and sets the fee at $1000. Person A's copa is $500, while Person B's copay is $200. Both have a total fee of $1000.
Now suppose person A's plan covers 50% but the fee is set at $600. Person B's plan is 80% but with a fee of $1500. Now person A and Person B both pay $300 despite the different total fees.
I had a root canal a few months ago and the price was around $1100. my out of pocket was $225. The procedure was virtually painless(the worst was keeping your mouth open that long) a little jaw stiffness after the fact for a couple of days. Quite the difference from the extreme sensitivity prior to the procedure.
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Does it have anything to do with your screen name ending in "doc"?
