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We have a BCBS ppo. I remember 10 or so years ago cleanings were covered %100 and cavities 80% under similar insurance. Recently I just had a root canal done. They said they covered 30% of the “allotted” amount. I’ve never heard that term before. Basically the root canal was $1500, they only cover 30% of the alloted amount which is $650 so I only get reimbursed 30% of that. In network 50%. And non of the Dr I go to are in network. Like all of them I call to check are out of network. Is this just the specific Blue Cross Blue Sheild policy or is this just how dental insurance is in general now?
I suspect that "allotted" is supposed to be "allowed" amount. The allowed amount is the amount insurance uses to calculate the percentage they cover. 30% out of network and 50% in network is pretty bad but that's what you signed up for. If you are looking for in-network providers then you should ask your insurance for a list.
None of what you mentioned is new. I think when they invented dental insurance it started with a yearly maximum of $1,000 and hasn't budged since. If MikeBear gets $1,500 that's the best I've ever heard. In the real world, there's not much you can do with that amount other than a cleaning and x-rays, maybe a filling or two. Anything else is over the limit right off the bat.
The "allotted" amount is what the insurance company pretends the procedure should cost in your area, so they will only cover their part of that amount, not of the real amount that the dentists in your area actually charge. 30% coverage is more like a coupon than insurance. Trust me, I've got a million dollar mouth without ever having had dental insurance, because I can't find a plan where the payout is more than $20 different from the premiums.
We are retired so we no longer have employer provided dental insurance but after finding out I needed to have two bridges and a bunch of crowns replaced I bought two dental policies that each have a $3500 limit. They start paying for major work right away, one pays 25% the first year, the other 30% but they coordinate benefits so from day one I only had a 45% copay. In January one policy will cover 50%, the other will stay at 30% until July when it will go up to 50%.
They aren't cheap, one is $60 a month, the other is $70 but I've saved a ton of money. I had $4500 of work done this year and my out of pocket was $2000. I'm going to have the remaining work done in January, the total is $6500 My out of pocket for the $6500 in work is 20% or $1300, as soon as the work is completed I am dropping one of the policies. It might sound crazy but the math works
If you are going to an in-network dentist, then you pay 70% of the allowed fee, not the dentist's regular fee. So you should have paid $455 with the insurance company covering the rest (unless you hadn't met your deductible yet, in which case that would be added, or if you've already met your maximum benefit allowance, in which you would have to pay the whole $650). Check your explanation of benefits (EOB) for more information if this is not what you were charged. Sometimes dentists try to get away with not reducing the fees down to the contracted allowance. (I worked in a dental office and handled the insurance claims for six years.)
Edited: I misread and now see that you saw an out-of-network dentist. Unfortunately, in this case, you do have to pay anything that's left. Always see an in-network dentist if possible! If you don't have anyone in your area, call your insurance company. They will either refer you to someone or allow you to go out of network for some procedures.
Location: East of Seattle since 1992, 615' Elevation, Zone 8b - originally from SF Bay Area
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Better yet, work somewhere that provides Delta for $6/month and marry someone that also has the same plan at their employer. Root canals are expensive, but implants are worse. I had two, and fortunately my annual maximum is doubled by using both policies. Dentists often charge less for cash, non-insurance, in some cases that can be cheaper than using insurance when you benefits are weak.
None of what you mentioned is new. I think when they invented dental insurance it started with a yearly maximum of $1,000 and hasn't budged since. If MikeBear gets $1,500 that's the best I've ever heard. In the real world, there's not much you can do with that amount other than a cleaning and x-rays, maybe a filling or two. Anything else is over the limit right off the bat.
The "allotted" amount is what the insurance company pretends the procedure should cost in your area, so they will only cover their part of that amount, not of the real amount that the dentists in your area actually charge. 30% coverage is more like a coupon than insurance. Trust me, I've got a million dollar mouth without ever having had dental insurance, because I can't find a plan where the payout is more than $20 different from the premiums.
The "allowed" amount is what the dentist has agreed to accept for the service for them to take your insurance. Dentists can't charge $3000 for a root and stick it to the insurance company. They would refuse to keep them in their network.
I have BC/BS dental insurance; the max/yr is $1,500. Preventative work is covered at 100%. Basic work is usually a 20% copay, and crowns/root canals (major services) are covered at 50% (after the $50 deductible). as long as I go to a dentist in Network. I researched all the dentists and endodontists in my area that are in Network before signing up.
The plan I selected is the Blue Dental Plus 1500, my monthly premium is $39 ($469/yr) which all in all pays for my cleanings twice a year plus xrays. Also, I inherited bad teeth and as a child my parents couldn't afford any dental work for us kids therefore I probably have more teeth with crowns than without, and have had several root canals. So for me, the insurance works very well because without it the cost to maintain my teeth would be quite expensive (have had this plan for four years).
If I were fortunate enough to have healthy teeth I probably would forego dental insurance.
We have a good Delta plan. Implants aren't covered but there's a fee schedule the dentist has to go by. So an implant might normally cost $2400 if you're not insured at all, our dentist can't collect more than $1800 from us for it. I had to have a root canal and crown, I think we paid $250 for the whole thing. A yearly checkup is some minimal thing, like $50, includes bitewings. A full panoramic set is part of our insurance plan, every 2 or 3 years (I don't remember the specifics). The thing that's really good about our plan is we have no yearly or lifetime max. We pay around $30 every other week, for the two of us through his job. We really should ditch his coverage since he wears dentures and doesn't need any actual dental work anymore - and denture maintenance isn't part of the coverage at all.
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