Total cost for cleaning plus exam here is $110, xrays are $50.

Sounds like your dentist did not file the insurance.

I agree about insurance not filed. If your teeth are good you might want to review your insurance. Many people do not realize that the cost of dental insurance if you have good teeth is more than what their dentist bill would be if they paid out of pocket. My recent visit was $144.00 plus $52 for xrays. xrays are only once a year since I have few problems with my teeth. When I looked at last signup time that the insurance would have been more than just paying out of pocket. It has been all my adult life. If you have problem teeth or children better not to take a chance.

I went first week of this month for cleaning and exam, and it was time for xrays. The bill submitted to insurance was $284. $45 of that is a fluoride treatment after cleaning - my dentist offers it to all patients and if insurance doesn't cover it they remove it from the bill. My insurance won't pay for it since I'm more than about 12 years old, my policy doesn't pay for fluoride for adults. My balance after insurance has paid will be $11.80.

Our dental policy with two cleanings each a year and maybe one of us getting a filling or something is about a break even deal. This year, it will pay to have had it, I'm having a back crown replaced next month. Most years I could have paid out of pocket and arrived at the same expense as the premiums.

Depending on the insurance there may be a maximum that the policy will pay. mortz you may want to look at that so you will not have a shock if they do not pay for the complete crown. Others will pay a percentage and you pay the rest.

My last cleaning was $260, and that did not include x-rays or flouride.

Most dental insurance will pay for only two cleanings per calendar year, and one set of x-rays.

My dentist charges $150 for cleaning/exam/x-rays. Then my dental insurance reduces the prices she can charge as a PPO....then it's FREE twice a year.

note: We pay $39.50 a mo for dental insurance for both of us Just had a crown done. Altho the dental insurance didn't pay anything, it reduced the cost by half! Well worth having insurance!

Call your dentist and ask about the billing. Like sushipup said, most dental insurance pays for only 2 cleanings per year and the dental office usually books your appts so you stay withing a 12 month cycle. We often get bills before insurance has paid everything......not unusual.

Yikes, insurance stinks here for medical but dental give two free cleanings a year.

Why does medical insurance stink in your area?

Keep in mind that medical insurance is more typical of traditional insurance. Other than in extreme cases and excluded conditions, it will usually cover greater than normal expenses to treat what befalls the insured individuals. It protects against a large loss.

Dental insurance, on the other hand, is more like prepayment contracts for services. You pay an annual premium, it covers certain items like regular cleanings and simple other procedures but not if greater than $X. Benefits are typically limited to only certain procedures and cap out at an annual maximum amount. It's not insurance in a traditional sense.

You are paying for those cleanings through your premiums. Some Medicare plans In this area do include dental and vision but the amount that is paid is very low.

Maifeur, yes I realize I'm paying for insurance but I'm pleased to have the best dental plan with the highest coverage amounts I've ever had.

Elmer - why does the insurance stink, let me count the ways. I'm on the "highest level" plan a large employer offers (through a national insurance company) and yet the in-plan physicians are limited to those participating in only one health care corporation. If there are no physicians of a certain specialty in-plan within a limited physical area there is no option to go outside the area or to a not in-plan physician and have that expense covered. There is no documentation/website info provided to even find out what are covered expenses and what steps are necessary to have a service covered. I would not expect insurance to cover routine or unnecessary stuff but this is a whole different situation than I've ever seen.

Compounding those issues, many of the physicians here have moved to concierge medicine so they are no longer troubled by all the insurance red-tape.

Raye No website for the insurance company? While some of the other things you wrote I somewhat agree with having had HMO coverage until the premiums and needs changed I too had the in-plan doctors but there were also what was called out-of-network to cover the rest. Just because a doctor is not in-plan does not mean you can not use them. It only means you have to pay them more.

What happens if you have to go to an emergency room in another part of the country if your insurance will only pay in network?

They have a website but it doesn't include information on what services are covered or what steps are covered, for example is a referral required for specialists or are second opinions required for some services.

Great question about emergency room visits and I have no idea because again no info provided. Also this is not HMO policy, they list it a PPO.

Back in the dark ages I always received a packet from the insurer that stated all this kind of stuff but no longer. The only thing printed is the price list for the different policy choices.

Yes, I could get care outside of the insurances limits but it just seems so irrational to have to when I pay plenty to have insurance.

Did you have work done earlier in the year which may have put you over your maximum for the year?

Dental insurance is not really like medical insurance, it's more like paying a fee to get a discount and many plans have an annual max of 1000 or 1500 or 2000.

The first dental insurance was offered around 1960 and the annual max was $1000. If the annual max were adjusted for inflation the max would now be $16,000, but the premiums would also be much more expensive

In the case of large employer plans, insurance companies often do little more than administer coverage alternatives that are chosen BY THE EMPLOYER or by them jointly with consultants working with the employer on cost management.

Every insurance company can administer any kind of converge, whether generous or stingy. It may be that the coverage in your area is limited to this one group because the insurance company's contract with this one group was at lower costs than other alternatives.

it sounds like you have a valid gripe but who you should direct your concerns to is the HR department of the sponsoring employer. The insurance company more likely than not is simply doing what they were told to do.

As far as plan communications is concerned, I think you're entitled under law to receive written material and access to a resources to address coverage questions.

Do you live in a small town? Or are you in or near an urban area? There should be no limitations on services simply because of the limitations of the contracted group. For this, you should be communicating both with the insurance company and with the employer.

Good luck

Here's a new one, I can read you'alls comments on my activity page but if I try to open the discussion in a new tab I get "page not found". Has this happened to anyone else?