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I've not been to the dentist since I was a kid. Hubby hasn't been in about 10 years. We've been in no position financially to go.
Finally we can. I've got insurance at work that covers the x-rays, exam, and a cleaning once a year for free.
So we made an appointment and hubby and I went in. All's fine. Me - no cavities or anything. I have 5 teeth that they said need to come out though. And they said I need a deep cleaning to get the ............. tartar........... plaque?? One of them from under my gum line. The total for me is $2000.
Hubby has a couple cavities and he needs a couple crowns on teeth that had cavities years ago and the teeth are beginning to crack. He also needs the deep cleaning. Damage for hubby $3500.
Insurance covers almost none of that. What they quoted is going to come out of our pocket.
They asked if we wanted to go ahead and make appointments. Well, right now we don't have $5500 laying around. We don't even have the $1200 for the deep cleaning they said we need. So I told them we'd like to do whatever the basic cleaning is that the insurance company pays for and we'll save up for the rest of it.
The girl said they won't do that though. They refuse to do the work the insurance company will pay for unless we pay for the other stuff they said we need first.
Now, I'm no doctor, I'm an accountant. I know nothing about dentistry. And for all I know there may be a reason for that policy they have. But I'm not sure. So, for the dentists or dental assistants out there, is there a medical reason or something that I'm not aware of that mandates they do the $1200 work out of pocket before they can do the other work the insurance company pays for?
$1200 for a deep cleaning?? I've been out of the field for about 6 years, but I can't imagine prices have gone up that much.
Did you see a dentist in your insurance network? They are obligated to provide services at the contracted rate that they have with your insurance, regardless of whether the insurance will pay for the procedures or not.
I'm guessing here, and from experience on the cost of dental care...
$1200 for scaling would translate to about $300 per quadrant which is about right if totally out of pocket. Most insurance companies cover this procedure at 60-80% depending on your type of coverage.
I think they may be insisting on not doing basic cleaning because scaling is a type of cleaning and the insurance company may look at the scaling as partly redundant after the regular cleaning, which also is not deep, and then may deny the scaling. I suggest things like fillings first if that's part of the treatment plan. Otherwise I'd go consult with another dentist if they are not willing to work with you.
The $1200 is for both of us, it's actually $660 each. I signed up for the basic HMO coverage in insurance if that makes a difference? I figured since it covered the Xrays, exam and annual cleaning that's all we'd need for now.
I just felt like they refused to do what the insurance company would pay for because it was contracted which means they won't make nearly as much as they would if they had us pay out of pocket.
Actually - hang on. I've got the estimates here.
Ok, for me, they charged:
$37 for therapeutic drug injection, by repo?? - Insurance pays zero
$66 for IV conscious sedation - Insurance pays zero
$215 for the same thing as above, insurance pays zero. Not sure why there are 2 charges for the same thing but different amounts??
Surgical removal of erupted tooth - there are 5 charges for this. $110 each, $70 out of pocket, $40 for each from insurance.
Total out of pocket to have the teeth removed $668
Irrigation per quadrant $27.50, insurance pays zero (Two of these)
Arestin - localized delivery $35, insurance pays zero (13 of these!!)
Perio scaling root planing, quadrant - $65, insurance pays $45 (two of these)
Total for their 'deep cleaning' $640
And then they have that a second time ^. They said they want to do one side and then have me come back another day to do the other side because it will make my mouth on the side that's done incredibly sore for several days and they don't want my entire mouth to hurt because I won't be able to eat.
For hubby:
Crown - $390 out of pocket, insurance pays $110
Cigna lab fee - $100, insurance pays zero
Desensitizing medication - $25, insurance pays zero
Core build-up, including any pins - $95, insurance pays $15
Total $610
There are two of those ^
Um, I just noticed, for hubby's deep cleaning, they've only got 7 of the fees for the Arestin. Any clue why?? His comes to $430 and there are two for him as well, so he'd have to come back a second time.
And then his big one is another of the crown ones, but it lokes like they'll do 2 crowns on that one for a total of $1220.
So, that's what they've got planned for us. And until we do all that they won't do the basic cleaning. So, a total of $5248 out of pocket and the insurance company is going to spring for a whole $1060 on top of that. I'm glad I'm only paying about $3 a month for that dental insurance or I'd be pretty ticked right now......
My advice: Ask CIGNA to give you all the dental codes for the procedures you quoted and ask them if any of those procedures can be claimed against medical. If there are any, just double check with your medical carrier again if they will cover those. There are dental procedures that can be covered under medical and medical under dental.
My advice: Ask CIGNA to give you all the dental codes for the procedures you quoted and ask them if any of those procedures can be claimed against medical. If there are any, just double check with your medical carrier again if they will cover those. There are dental procedures that can be covered under medical and medical under dental.
Best of luck!
Really?? I didn't know that. I'll have to give good old BC/BS a call!!!
Most teeth are losss from gum disease. Paradontal disease is caused by plaque that get below the gums and creats a spce between the gums and the teeth . There is also bacertia there in the plaque that can cause herat disesase problems. The loosening is what causes the tooth loss. When they deep clean and can treat with a anti-bacteria. Then it requires cleaning about every 3 months after that with check to see the closing of the gums to the teeth.Both muy wife and I had the deep cleaning and it is prtty common at ages like 50 when they start getting the space measurements that get worse.Dental insurance once you have pardonatial disease is a good deal because you are going to use alot of it very year for the cost.You can't expect much more for $3.00 a month.You have to look at the years you paid nothing to get to this state.
I had a deep cleaning almost 2 years ago. $1200 is about right. Our insurance did cover some of it though. It takes 4 visits, but I had mine done all at once. I had to have 2 cavaties filled and as long I was numb, they were going to do it all. I was there for 5 hours. I was numb and had the laughing gas, that in itself made it feel like was there for about an hour. Our insurance doesn't cover the gas, so we had to pay for that.
Needless to say I take great care of my teeth now because I never want that cleaning again. I realize that my teeth are worth every penny we paid for everything.
Since you enrolled in a DMO (HMO=medical, DMO=dental), you're list of potential dentists is limited. That's one of the downsides of being in a DMO is that you don't have freedom of choice. Nonetheless, you should call Cigna if you decide to switch dentists. Keep in mind that you only get exams/x-rays once or twice a year and there are time limitations, so the 2nd opinion may not be covered.
More than likely, the receptionist didn't quote the office procedure correctly. The reason you can't get a "light" cleaning when you need a "deep" cleaning is for legal reasons. When you get a "light" cleaning, or prophy, the office is certifying that your teeth are now free of tartar and plaque. Since that's not true, the office would then be committing fraud, in a sense. You can get something called a "debridement", which is intended to remove large chunks of tartar prior to a deep cleaning. That's essentially what you're asking for. However, that doesn't accomplish much since there's lots of tartar hidden underneath the gumline.
I can't think of a reason why you'd have to get a cleaning prior to other work (except in dental schools, where that's one of the criteria to be accepted as a patient). As the patient, you actually get to dictate what work gets done, what gets declined, and the timeline in which it happens. The dentist cannot tell you what to do. However, he or she is able to decline doing work which is unethical or illegal.
If a quadrant is $65, and there are four quads, that totals $260... what's the rest of it? Arrestin is charged per "site", which means per tooth. Conceivably, you could decline the Arrestin, irrigation, desensitization, and IV sedation. Whether the dentist would agree to that I don't know. It's more of an ethical issue than anything else.
The ethical issue is one of supervised neglect. If I feel like you need X, Y, and Z treatments, but you only want X, does my rendering you treatment X constitute proper care? Are treatments Y and Z so vital to the overall therapy that administering just treatment X is substandard care? Applied to your situation, is Arrestin a necessary component of the deep cleaning that to omit it jeopardizes your care? That's up to you and your dentist to decide.
Went thru this whole song and dance routine...Was initially told no can do the cleaning either. Told the dentist to do the damn 'regular' cleaning, bill insurance and get theirselves paid for it, since I was due it!! Well, a form for me to sign,stating I had been informed of *other* stuff but was electing the regular cleaning instead a this time, Magically appeared. I signed , they have have their CYA form, they cleaned, and I am shopping for a new "old school" dentist. Had a great talk with my old dentist back home about what to ask,etc. Suffice to say some dentists are overly agressive these days...
they sure spend a lot more time telling you payment options than they do explaining what they want to do!!!
IMO Find you a new dentist
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