topic Re: Periodontist ugh! in Wellness

Periodontist ugh!

Abrowneyegirl — Tue, 14 Jan 2020 17:49:58 GMT

So there is a local periodontist that I have used in the past and really like. One practitioner in the office and most state of the art imaging equipment than I have seen at any other office.

He is a young doctor very nice and top-rated.

I was referred to him again by a dentist and an endodontist and when I went to schedule the appointment I was promptly informed that they no longer participate in any insurance. They are self-pay but will provide a receipt so that I can deal with my insurance company for reimbursement.

Apparently he built up enough of a practice that he can no opt-out of the insurance game.

His next opening is the first week in MAY!!!! aughh

Although we have dozens of periodontists in our area but this one is hands down recommended by friends, family, dentists and dental surgeons. My DH and I have used him before and he is very good.

Re: Periodontist ugh!

phoenixbrd — Tue, 14 Jan 2020 18:12:31 GMT

It doesn't seem to matter if you have insurance or not...everything is out of pocket. I have what is considered good medical/dental insurance through work. Last year we spent over 10K on my husband's mouth....desperately needed. And our excellent dentist provided documentation...nope, not a penny. Our through deep cleanings are not even covered. It is a farce. The restrictions on the dental insurance and what they will cover make dental insurance meaningless. Tried a cheaper insurance through my work one year and was sent to mill with incompetent doctors. So there is no winning. We now just expect to pay.

Re: Periodontist ugh!

Icegoddess — Tue, 14 Jan 2020 18:11:11 GMT

If you have to buy dental insurance out on the open market, it's a huge joke. They claim to cover all sorts of things, but when it comes down to it, they decide what you need, not the dentist, and they will only pay for what they have decided you need which is almost always the cheapest option.

I have had to pay lots of money in the last few years for crown replacements. I trust my dentist to know the best option for me instead of the cheapest crown material available.

Luckily, when I had Periodontal work done I was still with my company's very good insurance plan which included dental (long before the ACA came along).

My dentist will file my insurance for me, but he is not in-network with any dental plan.

Re: Periodontist ugh!

CelticCrafter — Tue, 14 Jan 2020 18:21:44 GMT

I don't care how well recommended he came, first week in May? I'd be looking for other recommendations.

Re: Periodontist ugh!

Helen852 — Tue, 14 Jan 2020 18:44:40 GMT

Dental coverage is strange. I've had it all through my employment and into retirement as well. If I want a crown, I have to pay it upfront with my dentist because they're are not in-network. OK, that's fine, but I'm liable for 80% so the dental office does submit to insurance and I get the 80% back. If I want a filling, the insurance doesn't cover the newer materials they use for fillings; so again, out of pocket then reimbursement.

We stay with the dentist because they have state of the art equipment and have been with them for over 25 years.

Re: Periodontist ugh!

Travone — Tue, 14 Jan 2020 18:59:33 GMT

Whoa.....what a way for him to keep his costs down.....he doesn't have to employ anyone to work with the insurance groups. Puts all the work on the patient who isn't normally well versed in that area. I hope other doctors don't start to do this. What a nightmare.

Re: Periodontist ugh!

Abrowneyegirl — Tue, 14 Jan 2020 19:22:53 GMT

@Travone wrote:
Whoa.....what a way for him to keep his costs down.....he doesn't have to employ anyone to work with the insurance groups. Puts all the work on the patient who isn't normally well versed in that area. I hope other doctors don't start to do this. What a nightmare.

You will typically only see this in doctors that are in high demand because they are top of their field.

SOME actually charge less for a cash-based system because the practice is saving a LOT of money.

I have not noticed any price advantage for self-pay in the dentistry world.

Re: Periodontist ugh!

DrakesMomma — Tue, 14 Jan 2020 19:27:18 GMT

@Abrowneyegirl wrote:
@Travone wrote:
Whoa.....what a way for him to keep his costs down.....he doesn't have to employ anyone to work with the insurance groups. Puts all the work on the patient who isn't normally well versed in that area. I hope other doctors don't start to do this. What a nightmare.
You will typically only see this in doctors that are in high demand because they are top of their field.
SOME actually charge less for a cash-based system because the practice is saving a LOT of money.
I have not noticed any price advantage for self-pay in the dentistry world.

@Abrowneyegirl - You are on to something. It costs a lot of money for providers to bill insurance companies. Some providers see it as a cost of business but more aren't.

Re: Periodontist ugh!

Abrowneyegirl — Tue, 14 Jan 2020 19:29:43 GMT

@phoenixbrd wrote:
It doesn't seem to matter if you have insurance or not...everything is out of pocket. I have what is considered good medical/dental insurance through work. Last year we spent over 10K on my husband's mouth....desperately needed. And our excellent dentist provided documentation...nope, not a penny. Our through deep cleanings are not even covered. It is a farce. The restrictions on the dental insurance and what they will cover make dental insurance meaningless. Tried a cheaper insurance through my work one year and was sent to mill with incompetent doctors. So there is no winning. We now just expect to pay.

Dental insurance is a bit of a joke. Even for things that are supposed to be covered they fight tooth and nail (no pun intended) to not pay. Anything other than a cleaning a battle ensues.

For the last 3 years, we have spent an average of $8400 out of pocket a yr on dental expenses!! Every year my DH says "what do people do who can not afford this?" My answer everytime- 'you lose your teeth.'

Thank heavens we do not have any major problems like some people. We both take very good care of our teeth.

Re: Periodontist ugh!

arrabella — Tue, 14 Jan 2020 20:33:32 GMT

We are both retired but still carry our Delta dental insurance through the company he retired from. I just had to have one of my permanate bridges replaced as my old one broke. The insurance covered 80%, my share of cost was just under $800.00.

Re: Periodontist ugh!

2blonde — Tue, 14 Jan 2020 21:00:09 GMT

@Abrowneyegirl I've always taken very good care of my teeth too, but stuff happens as ou get older. Last year I had to have a tooth pulled. I was in total shock, but in even more shock after all the work was done. It was a major molar, so I went through the long process of getting an implant, and eventually the crown last month. The insurance paid a small portion of it (pulling the tooth and the crown). My total cost for the one tooth was about $4,500.

Re: Periodontist ugh!

Abrowneyegirl — Tue, 14 Jan 2020 21:04:00 GMT

@arrabella wrote:
We are both retired but still carry our Delta dental insurance through the company he retired from. I just had to have one of my permanate bridges replaced as my old one broke. The insurance covered 80%, my share of cost was just under $800.00.

Wow! You have great dental insurance.

I told my mom before she retired to get EVERY dental repair done that she needed. Even if she had to work an extra year get it ALL done. She was in a grandfathered insurance program that was scheduled to 'disappear' if she retired or changed hours.

My DH needed a permanent bridge recently due to a congenital defect. Between the prep work and the bridge......some things were covered at 50% some at 80% (deductible met) it was eye popping in costs.

It was a shame it could not be covered better as it was not his fault.

Re: Periodontist ugh!

software — Tue, 14 Jan 2020 22:58:34 GMT

I have gum problems also, all the new technology is amazing now, compared to decades past. If he's that good, it's worth the wait but can you get on the cancellation list? Most offices keep one in case someone cancels, they start calling the list to see if someone can come in. Even if you think it wouldn't work for you, get on the list anyway, you can always decline and they go to the next person on the list.

@Abrowneyegirl wrote:
So there is a local periodontist that I have used in the past and really like. One practitioner in the office and most state of the art imaging equipment than I have seen at any other office.

He is a young doctor very nice and top-rated.

I was referred to him again by a dentist and an endodontist and when I went to schedule the appointment I was promptly informed that they no longer participate in any insurance. They are self-pay but will provide a receipt so that I can deal with my insurance company for reimbursement.

Apparently he built up enough of a practice that he can no opt-out of the insurance game.

His next opening is the first week in MAY!!!! aughh

Although we have dozens of periodontists in our area but this one is hands down recommended by friends, family, dentists and dental surgeons. My DH and I have used him before and he is very good.

Re: Periodontist ugh!

software — Tue, 14 Jan 2020 22:59:45 GMT

If congenital, could it be covered under medical?

@Abrowneyegirl wrote:
@arrabella wrote:
We are both retired but still carry our Delta dental insurance through the company he retired from. I just had to have one of my permanate bridges replaced as my old one broke. The insurance covered 80%, my share of cost was just under $800.00.
Wow! You have great dental insurance.

I told my mom before she retired to get EVERY dental repair done that she needed. Even if she had to work an extra year get it ALL done. She was in a grandfathered insurance program that was scheduled to 'disappear' if she retired or changed hours.

My DH needed a permanent bridge recently due to a congenital defect. Between the prep work and the bridge......some things were covered at 50% some at 80% (deductible met) it was eye popping in costs.
It was a shame it could not be covered better as it was not his fault.

Re: Periodontist ugh!

Abrowneyegirl — Wed, 15 Jan 2020 00:32:35 GMT

@software

Great minds think alike!! No could not get it covered.

A few years ago I battled for 6 months with my dental insurance company. I needed braces or Invisalign to correct 2 teeth that shifted out of place causing me terrible tooth pain from the pressure and was damaging another tooth due to the impact of the bite out of alignment. The dentist provided documentation and photo evidence that the treatment was not cosmetic the changes were not visible. They refused to pay.

Re: Periodontist ugh!

arrabella — Wed, 15 Jan 2020 04:57:41 GMT

@Abrowneyegirl wrote:
@arrabella wrote:
We are both retired but still carry our Delta dental insurance through the company he retired from. I just had to have one of my permanate bridges replaced as my old one broke. The insurance covered 80%, my share of cost was just under $800.00.
Wow! You have great dental insurance.

I told my mom before she retired to get EVERY dental repair done that she needed. Even if she had to work an extra year get it ALL done. She was in a grandfathered insurance program that was scheduled to 'disappear' if she retired or changed hours.

My DH needed a permanent bridge recently due to a congenital defect. Between the prep work and the bridge......some things were covered at 50% some at 80% (deductible met) it was eye popping in costs.
It was a shame it could not be covered better as it was not his fault.

After reading about all the problems and lack of coverage so many of you have experianced, I'll count my blessings.

Re: Periodontist ugh!

Icegoddess — Wed, 15 Jan 2020 05:08:36 GMT

@arrabella wrote:
We are both retired but still carry our Delta dental insurance through the company he retired from. I just had to have one of my permanate bridges replaced as my old one broke. The insurance covered 80%, my share of cost was just under $800.00.

@arrabella, I had Delta Dental before I got laid off. Thank goodness I was able to keep it under COBRA while I had to get braces and then an implant. It was good insurance.

Re: Periodontist ugh!

Carmie — Wed, 15 Jan 2020 05:17:09 GMT

I used to have wonderful dental insurance. It covered almost everything at 100%. Now that I have Medicare, I don't have dental insurance.

I only get my teeth cleaned twice a year anyway. I never used any of the other dental benefits when I had it.

I am beyond fortunate that I have really good teeth and gums. No problems...ever.

Re: Periodontist ugh!

arrabella — Thu, 16 Jan 2020 02:05:20 GMT

@Icegoddess I have a friend that used to work in a dental office and she told me that Dental was the best. They also offer free cleanings 3x/yr for the both of us. It used to be 4x/yr but it was dropped to 3 a couple of years ago. We are thankful for the insurance we have from my husbands old employer.

Re: Periodontist ugh!

blackhole99 — Tue, 21 Jan 2020 01:10:19 GMT

Basic dental care in the US was always expensive and usually out of reach for the average person without some kind of dental insurance. If you need to have anything that requires any kind of skill, like restoration, you may have to take out a loan. There's a reason these dentists don't pull teeth anymore unless you opt for an implant. KACHING!