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Medical Forum / General / Dentistry / October 2005Dental Insurance discussion
Dental insurance, like medical insurance, is here to stay. Some like it and some don't. I think it sucks. But then so does medical insurance, but in a different way. Medical insurance sucks because it is SOOOO frickin' expensive! But dental insurance sucks because you get almost no benefit from it. At least with medical insurance you get major things taken care of for a very low price. I have had MRI's, nerve conduction studies, etc. all for zero charge to me (outside my $525 or so a month insurance policy). I get doctor office visits for $25, which to me seems high for insurance; and I get prescriptions for $10-25 depending on what it is. Sometimes some prescriptions can be gotten cheaper in Canada or Mexico, WITHOUT insurance, based on a $25-25 co-pay. And going to a doctor is cheaper in Panama or Costa Rica without insurance, than it is here WITH insurance. Before you knock the medical care in these countries, let me say that I have experience and can say that it is in many ways BETTER than here in the U.S.A.. Okay; now Dental Insurance. Delta PPO sucks because you pay like $30/month in order to get free cleanings and free xrays and a certain amount of discounted procedures. BUT you only get $1000 top benefit per year, so really you are paying $360/month to get a POTENTIAL pay out of $1000 which would be a $640 benefit. So you are paying $360 at a chance of getting $640. But if you don't use your benefits, you are wasting your money. For example, last year I paid $60/month for my wife and I's dental insurance. She got her teeth cleaned and fixed when she was visiting her relatives in Mexico, for almost nothing. I did not go to the dentist last year. So we gave them $720 and got ZERO benefit from it. Sounds like a good business model... for the insurance company! Okay, I was dumb not to go in for at least my cleaning, but the fact is many people do the same, so Delta Insurance is the one doing the cleaning - cleaning up on people's monthly insurance payments. And it's not like the medical HMO where most stuff is free or cheap; no, with Delta PPO, you still pay relatively high prices for things like crowns and bridge work, etc. on top of your monthly payment. If I go to the doctor and find I need a cast on my broken arm, it is included in the price of my insurance. But if I go to the dentist and am told I need a bridge, I will pay dearly for it. Oh! I need IMPLANTS!? Sorry, "we don't cover THAT!" Dental insurance is almost worthless for most things one needs it for. As for the "business model" of dental insurance, I don't know if it's a good one or not; probably not; but it is what we have to deal with. With Medical HMO insurance, I can get an MRI for "Free", I can get many expensive analyses done for "Free". But with dental insurance, nothing except SOME x-rays, and cleanings are free, and usually even cleanings aren't free because the (crooked?) dentist will tell you that you need a "Deep" cleaning and that costs $100. Or even with fillings: oh, but you need a PORCELAIN filling; insurance doesn't cover that, that will be $90 extra...etc etc ad nauseum... Insurance is a scam designed to make insurance companies rich. It isn't necessarily good for medical care or dental care, neither the dentists, doctors nor their patients. But it is the major way things are done here in the U.S.. Personally I think Dental Insurance is the biggest scam of all because you get so little benefit for your money. At least with HMO medical insurance if some major accident happens or you just get really sick like with cancer or something, you are completely covered. But with dental insurance, there are limits to the coverage, and you almost always end up paying a lot of "out of pocket" costs, usually so much that the insurance benefit is negligible. Also, the way dental insurance is structured it turns dentists into crooks, telling patients they need things they don't really need, or selling the patient on some procedure that is not covered, such as teeth whitening, with used-car sales tactics. It's been my experience - not to disparage anyone here - that many dentists ARE crooks. They tell you that you need a bridge, you get the bridge but the work causes you to need a root canal; you get the root canal and now have to have the bridge re-done; you get the bridge done but it's done poorly and now has to be re-done again. Now the root canal that was done causes you to need an apicoectomy. Now another root canal that was done causes you to lose a tooth... But no dentist will say that the offending dentist was a quack and should be sued... In the words of my current dentist, "The root canal was done poorly, that is why the tooth has to be pulled." So the dentist screwed up my tooth? Can I sue him for malpractice?" "No, it isn't malpractice".... We've had 2 out of 3 dentists in Los Angeles who have totally screwed up our teeth and charged us an arm and a leg to do it! Is dental insurance at fault? > Dental insurance, like medical insurance, is here to stay. Some like > it and some don't. I think it sucks. To conserve bandwidth I didn't repeat all of your words, but you said it all so well that you seem to have left little to discuss. Vaughn >> Dental insurance, like medical insurance, is here to stay. Some like >> it and some don't. I think it sucks. [quoted text clipped - 3 lines] > >Vaughn Yp to cnsrv bndwth evn mre I omt mny vwls. jeol (as Falp likes to call me). >Dental insurance, like medical insurance, is here to stay. Some like >it and some don't. I think it sucks. But then so does medical [quoted text clipped - 13 lines] >countries, let me say that I have experience and can say that it is in >many ways BETTER than here in the U.S.A.. No wonder businesses manufacture in the Far East. Joel >Okay; now Dental Insurance. Delta PPO sucks because you pay like >$30/month in order to get free cleanings and free xrays and a certain [quoted text clipped - 61 lines] >dentists in Los Angeles who have totally screwed up our teeth and >charged us an arm and a leg to do it! Is dental insurance at fault? >>Dental insurance, like medical insurance, is here to stay. Some like >>it and some don't. I think it sucks. But then so does medical [quoted text clipped - 83 lines] >>dentists in Los Angeles who have totally screwed up our teeth and >>charged us an arm and a leg to do it! Is dental insurance at fault? > Okay; now Dental Insurance. Delta PPO sucks because you pay like > $30/month in order to get free cleanings and free x-rays and a certain > amount of discounted procedures. BUT you only get $1000 top benefit > per year, so really you are paying $360/month to get a POTENTIAL pay > out of $1000 which would be a $640 benefit. So you are paying $360 at > a chance of getting $640. Not defending or attacking, but trying to add to the conversation: Dental Insurance is a misnomer. It actually is a pre-paid benefit. It was designed as a "pearl" for the employer to offer employees, so the employer can attract good employees or keep the ones he has. It was never designed as an actual "insurance". True Insurance has you pay a premium for something which you probably will never need (like house fire, rolling your car over, getting cancer, etc.). The odds are that you will not collect on those items, so the policy is very cheap (comparatively). You see medical insurance getting expensive in recent years as the public has learned how to use more medical care. Dental insurance is simply money paid into a fund and dispersed until the funds are gone. The funds are administered by a company who intends to make a good profit for their share-holders; so they make sure that a large portion of the funds never are paid back out. If every policy holder paid $400 in premiums and received $800 in benefits, the carrier would go out of business in one year. The other side of employer purchased plans is that the annual maximum of $800-$1500 (some plans now go up to $2000/year), was set in 1967. At that time, you could buy a brand new _fancy_ car for $3500. So, the dental coverage was 1/3 to 1/2 the price of a very nice car. Today, an equivalent car would cost $40,000. So, dental maximums should be $15,000/year. They are not that high because employers have not chosen to pay the higher premiums required. Employers are only going to raise the annual maximum when they are forced to do so in order to attract or keep staff. They are not going to increase their payroll overhead greatly without getting any production increases to go with it. Especially in today's competitive market, they are not going to increase benefits unless they have no other way of getting and keeping staff. If you buy dental insurance on your own, you are guaranteed to get less benefits than your premium. In such a case, the carrier cannot spread their risk out over a few thousand people. They can only spread the risk over the number of people in your family. Carriers know that people ONLY buy dental insurance on their own when they have lots of dental work needing to be done. So, they make sure they make their profit by limiting benefits. Discount plans (like Ameriplan), only sell you a list of offices which (at one time) offered to give discounts to people enrolled in the discount plan. Usually, the offices are still listed by the plan after the office stops participating. The plan will also list the same dentist and the same office 5-10 times on their list, so that the list of providers looks to be very long. In reality, there is usually only 2-4 offices within a 40 mile radius who will participate with the discount plans, and these are often not the offices with outstanding reputations. Rural areas will often have much fewer offices willing to participate. You could discuss the merits of getting medical and dental care in poorer countries. Some of the care in those locations is outstanding. However, I have yet to hear of a US citizen being impressed with the hospitals in Mexico. Maybe that is because most of the ones I hear about are in resort areas, but one would think that those areas would have the funds to develop good facilities. Since you are choosing to get your care in the USA, that you do not have enough confidence in the Mexican system to get your care there?  Signature/ Amatus / > Dental insurance, like medical insurance, is here to stay. Some like > it and some don't. I think it sucks. But then so does medical [quoted text clipped - 79 lines] > dentists in Los Angeles who have totally screwed up our teeth and > charged us an arm and a leg to do it! Is dental insurance at fault? It is going to take a lot more people to realize what is happening before anything will change. Direct Reimbursement is a much better idea and does away with the insurance company games. Unfortunately, most companies are used to dealing with the insurance companies and get sold whatever the insurance industry sells. If you listen to the insurance presentations, "they are doing their best to give the employees the most coverage for the least cost" (I was on the local school board for 12 years and I've heard them over and over). :-( Dartos >>Okay; now Dental Insurance. Delta PPO sucks because you pay like >>$30/month in order to get free cleanings and free x-rays and a certain [quoted text clipped - 55 lines] > you do not have enough confidence in the Mexican system to get your care > there? > It is going to take a lot more people to realize what is > happening before anything will change. [quoted text clipped - 10 lines] > :-( > Dartos Is this Fawks? Why the name change? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 I was changing isps anyway and it just seemed fit in with Armetus and Carabelli. (Dartos was the name of my intramural basketball team during dental school) Dartos >> Dartos > > Is this Fawks? Why the name change? > > Steve > I was changing isps anyway and it just seemed fit in with > Armetus and Carabelli. (Dartos was the name of my intramural > basketball team during dental school) For a laugh, do a google on Dartos Signature/ Amatus / > > I was changing isps anyway and it just seemed fit in with [quoted text clipped - 8 lines] >> >> Steve >> I was changing isps anyway and it just seemed fit in with >> Armetus and Carabelli. (Dartos was the name of my intramural >> basketball team during dental school) > > For a laugh, do a google on Dartos If you had seen them play that would have been your first choice for a name too. carabelli For a laugh, do a google on Dartos Reply. PLEASE DO NOT SHOOT the messenger: >From Wikipedia, the free encyclopedia. (Redirected from Dartos muscle) The dartos is a layer of smooth muscular fiber. In males it is termed tunica dartos and lies beneath the skin of the scrotum. In females, the same muscle fibers are less well developed and termed dartos mulierbris, lying beneath the skin of the labia majora. The tunica dartos acts to regulate the temperature of the testicles, which promotes spermatogenesis. It does this by expanding or contracting to wrinkle the scrotal skin. Contraction reduces the surface area available for heat loss, thus reducing heat loss and warming the testicles. Conversely, expansion increases the surface area, promoting heat loss and thus cooling the testicles. The dartos muscle works in conjunction with the cremasteric muscle to raise the testis but should not be confused with the cremasteric reflex. In older males the dartos muscle loses its tone, and tends to cause the scrotum to be smoother and to hang down further. Why would a bunch of dental students use this as their team name? I think you can figure that out. I should have known someone would go exploring. I could have used lateral rectus, but Dartos just popped in my head. So much for spur-of-the-moment decisions. Dartos > For a laugh, do a google on Dartos > > Reply. PLEASE DO NOT SHOOT the messenger: > >>From Wikipedia, the free encyclopedia. > (Redirected from Dartos muscle) Why would a bunch of dental students use this as their team name? I think you can figure that out. Reply. Must be a bunch of guys. TRhis name probably would not fly on a coed team. Reminds me of the men's volleyball team that called themselves "nads" So the cheerleaders would chant "Go.... " (whatever...?) It's a guy thing. They think it is funny---> har, har funny... but not hah, hah funny. -Sue > I was changing isps anyway and it just seemed fit in with > Armetus and Carabelli. (Dartos was the name of my intramural [quoted text clipped - 7 lines] > > > > Steve Dartos, Dartos . . . I thought that was one of the Three Musketeers. - dentaldoc > It is going to take a lot more people to realize what is > happening before anything will change. [quoted text clipped - 10 lines] > :-( > Dartos DR is just one step closer to companies saying here is $500 bucks...take care of your teeth or go buy a TV. Do you really think that is a step in the right direction. I agree with everyone that dental insurance (and insurance companies in general) cause plenty of headaches, but a lot of my income comes thru insurance companies. I am certain that alot of care that gets done would not get done if people could use that benefit to take a vacation or make a downpayment on a new car. T >>It is going to take a lot more people to realize what is >>happening before anything will change. [quoted text clipped - 13 lines] > DR is just one step closer to companies saying here is $500 bucks...take > care of your teeth or go buy a TV. But that ISN'T how it works, does it Tony? These are funds dedicated to dental care. Of course, these are dollars that could be alternatively dispensed as salary. But that could be done with insurance premium dollars too. Steve Do you really think that is a step in the > right direction. I agree with everyone that dental insurance (and insurance > companies in general) cause plenty of headaches, but a lot of my income [quoted text clipped - 3 lines] > > T SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > > DR is just one step closer to companies saying here is $500 bucks...take > > care of your teeth or go buy a TV. [quoted text clipped - 5 lines] > > Steve I know how DR works...I didn't mean to imply (and didn't write) DR dollars can be used for anything....I just don't think small to mid-size companies will want to be bothered with the extra work of dealing with the extra work DR requires and more would be inclined to just say here you go. Sure they could go with a DR administrator, but isn't that just a different type of third party involved in the process taking funds from actual care? You are right, just giving people extra salary instead of dental coverage could be done with insurance premiums as well, and in fact IS being done more and more. If off the shelf dental plans become a thing of the past, I think that many will not simply roll into DR programs, they will just abandon "dental benefits" all together. I don't see that as a good thing. T Someone mentioned going to Mexico for dental care. Here is some info of interest (Check out Dr. Lewis's blogsite. There are links to an article on this and some comments made) excerpt from March 21, 2005 blog entry by Dr. Shad Lewis located: http://wyomissingsmiles.blogspot.com "Think Dentists Are Too Expensive? If you choose the cheaper route, you may not be getting what you think you are... Dentists in a Mexican border town want to defend their industry and help American tourists searching for dental care in their country. This all comes after an Action 4 News investigation in February cautioning tourists about possible fake dentists operating across the border. You can read the rest of the article here - " Regards, Sue Getting dentistry done in Mexico is a very iffy proposition, but it can be done successfully, and far cheaper. The way to do it is to get specific recommendations from Americans who've been to a certain dentist and had the same procedure you are getting. If you can find a dentist that a number of Americans recommend and who has done the procedure you need done, with success, then chances are you can use that dentist and get very good work for about 1/4 or less the price. I do not know why it is so cheap in Mexico (insurance?), but the fact is, it is. The key is getting a good dentist, AND making sure THAT Dentist does the work. My wife had some dental work done and she had her sister who lives there recommend a guy who teaches dentistry at the University there who is said to be a great dentist. However, when she went for her appointment, he was not there and his office partner did the work. As a result she now has some bad bridge work that is going to need to be fixed and a root canal that will have to be re-done. If I had the time to spend in Mexico, I would seek out a good implant dentist and go live there while I was getting my implant therapy. The cost would be probably about $500 per implant, including auxilliary fees, except for maybe if major bone graft had to be done, in which case I would be skeptical of getting that done in Mexico. Their hospitals are dangerous. >if major bone graft had to be done, in which > case I would be skeptical of getting that done in Mexico. Their > hospitals are dangerous If you don't trust their hospitals which are run by corporations which have to answer to federal regulations and inspections, how do you trust the local dental offices ? Signature/ Amatus / > > Getting dentistry done in Mexico is a very iffy proposition, but it [quoted text clipped - 22 lines] > case I would be skeptical of getting that done in Mexico. Their > hospitals are dangerous. >>if major bone graft had to be done, in which >> case I would be skeptical of getting that done in Mexico. Their [quoted text clipped - 3 lines] >to answer to federal regulations and inspections, how do you trust the local >dental offices ? Personal experience and referrals/recommendations from others. Like I said, it's all about getting a referral to a GOOD one. They have a LOT of bad ones there. Though my wife will tell you they have a lot of bad ones here in L.A., too. The first dentist she saw here gave her bad bridge work and caused her to need 2 root canals. (She had NO pain or bothersome problems when she went to him.) The 2nd dentist she saw effed up her root canal causing her to need an apicoectomy. (We were told by 3 dentists who saw the xrays that he effed up; and in the end he paid us our money back for the bad root canal.) So she's batting 0 for 2 here in Los Angeles. > However, I >have yet to hear of a US citizen being impressed with the hospitals in [quoted text clipped - 3 lines] >you do not have enough confidence in the Mexican system to get your care >there? I know a lot about Mexico and I can tell you that I would never want to enter a hospital in Mexico! Hospital care in Mexico has a very bad reputation. Panama and Costa Rica fare better, particularly Panama City, Panama. As for dental work in Mexico, I would get it done there, but usually things like implants take time and I don't have the time to spend there, and if I flew back and forth, the plane fare would pretty much negate the money I'd save, at least a good portion of it. If I was retired and had the ability to go live there for 3-6 months, then, yes, I'd find a good recommended implant specialist there and get it done there for about 1/4 the price of the U.S.. >If I was >retired and had the ability to go live there for 3-6 months, then, >yes, I'd find a good recommended implant specialist there and get it >done there for about 1/4 the price of the U.S.. Why wait ? Move there now. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>If I was >>retired and had the ability to go live there for 3-6 months, then, [quoted text clipped - 4 lines] > >Move there now. Kill filed. >>>If I was >>>retired and had the ability to go live there for 3-6 months, then, [quoted text clipped - 5 lines] >>Move there now. >Kill filed. Thanks ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Okay; now Dental Insurance. Delta PPO sucks because you pay like > $30/month in order to get free cleanings and free xrays and a certain > amount of discounted procedures. BUT you only get $1000 top benefit > per year, so really you are paying $360/month to get a POTENTIAL pay > out of $1000 which would be a $640 benefit. So you are paying $360 at > a chance of getting $640. If your stock broker got you $1000 for a $360 investment you'd think he was a genius. If you need a lot of care buying $1000 benefit for $360 is a damn fine investment, if you don't, it isn't...why is this a scam? It would seem like a scam if you paiud your $360 and when you needed it, they paid nothing. The fact you asked for nothing and got what you asked for seems like what was supposed to happen did. > But if you don't use your benefits, you are wasting your money. For > example, last year I paid $60/month for my wife and I's dental [quoted text clipped - 14 lines] > IMPLANTS!? Sorry, "we don't cover THAT!" Dental insurance is almost > worthless for most things one needs it for. Are you also surprised when your hamburger doesn't taste like filet mignon? Do you know what your health insurance costs? I can tell you it is a lot more than $30. > As for the "business model" of dental insurance, I don't know if it's > a good one or not; probably not; but it is what we have to deal with. [quoted text clipped - 5 lines] > fillings: oh, but you need a PORCELAIN filling; insurance doesn't > cover that, that will be $90 extra...etc etc ad nauseum... Free? You must have health insurance that someone else pays for. My "free" MRI costs me and my family over $1500 a month! > Insurance is a scam designed to make insurance companies rich. It > isn't necessarily good for medical care or dental care, neither the > dentists, doctors nor their patients. But it is the major way things > are done here in the U.S.. A big problem with the insrance system is the way people percieve it and use it. You feel the pain of dental costs and act accordingly, and probably defer care you don't feel is essential. On the other hand, you'd probably never question the need for that "free" MRI because, well, its free! I agree that our system makes a lot of money for insurance companies...and those dollars do little or nothing to actually benefit anyone's health...however, I don't agree with you that the present insurance system is as bad for everyone as you say. > Personally I think Dental Insurance is the biggest scam of all because > you get so little benefit for your money. At least with HMO medical [quoted text clipped - 20 lines] > dentists in Los Angeles who have totally screwed up our teeth and > charged us an arm and a leg to do it! Is dental insurance at fault? You have many interesting views on this subject...thanks for sharing. T This is a GREAT discussion. I must add however that some employers offer a great benefits package where the dental insurance is worth it if one takes advantage of it. Ex. I pay $3.69 bimonthly ($88.56/yr) for a Delta traditional plan. Having this insurance encourages me to keep up with my 6 month check-ups. If more work is required, I have additional coverage up to $5000. So for me this is defintiely a good deal. -Sue > This is a GREAT discussion. I must add however that some employers > offer a great benefits package where the dental insurance is worth it [quoted text clipped - 8 lines] > > -Sue DR is a better deal for the employer and employee carabelli DR is a better deal for the employer and employee carabelli Carabelli, Please explain. All I know is it is a good deal for me. How can I get 2 teeth cleanings and preventive works any cheaper than this? P.S. Bimonthly --> I mean 2x per month. I always confuse this term: every other versus 2x/per? > DR is a better deal for the employer and employee > [quoted text clipped - 7 lines] > P.S. Bimonthly --> I mean 2x per month. I always confuse this term: > every other versus 2x/per? You're not seeing the big picture. The employer can provide more $$ for dental treatment by eliminating insurance company profits. Pay to set up the plan, pay an administrator (optional), fund the program and no employer paid insurance premiums = more $$ for dental benefits. And still provided with pre-tax $$. http://www.ada.org/public/manage/insurance/dr.asp carabelli You're not seeing the big picture. Reply. Perhaps not, but Medtronic is pretty "smart." :-) Thanks for the link. I will take a look. Q: Even if medical ins is a better deal than dental ins is... you cannot argue that from my personal standpoint taking advantage of this benefit, benefits me....correct? .. or are you indicating that I do not need preventive 6-mo check-ups... BTW, I have no control over the benefit packages that our company decides to offer. Thanks for the info, Sue Carabelli- HEY... maybe I should pass this informtaion along to upper management! Thanks -Sue > You're not seeing the big picture. > [quoted text clipped - 9 lines] > BTW, I have no control over the benefit packages that our company > decides to offer. OK, I will type this very slowly. Employer expenses plus employee contributions to run a DR are less than Employer expenses plus employee contributions to provide dental insurance. That means when an employer elects to switch to a DR and even decides to fund with a little less than was spent on the old dental insurance - Sue gets more tax free dollars to spend on dental care. carabelli > > DR is a better deal for the employer and employee > > [quoted text clipped - 17 lines] > > carabelli I think this is a plausible option for a big company with the expertise to handle a lot on their own, and therefore get some real savings..but for smaller companies who need to involve an administrator isn't it just a different middle man that is being paid? T >> > DR is a better deal for the employer and employee >> > [quoted text clipped - 26 lines] > > T Well, for some reason it has not caught on. I think the better alternative is the HSA. My staff doesn't quite get it though. It is a wonderful alternative. Buy a high deductible, give the diff to yourself and employees, and it rolls over. You could end up with a bucketfull for long term care etc. Worth looking into. carabelli It takes very little to administer for a few employees. DR hasn't caught on because there is no big money pushing it. Insurance companies have reps pounding the pavement and ads all over the place. DR just sits in a corner waiting for someone to discover it. Kind of like the difference between Imetrex and the NTI. Dartos >>I think this is a plausible option for a big company with the expertise to >>handle a lot on their own, and therefore get some real savings..but for >>smaller companies who need to involve an administrator isn't it just a >>different middle man that is being paid? >> >>T > Well, for some reason it has not caught on. I think the better alternative > is the HSA. My staff doesn't quite get it though. It is a wonderful [quoted text clipped - 3 lines] > > carabelli I'd bet a dollar to a pig turd that the insurance cost is way more than $88.56 per year. That means that the employer is picking up the rest of the tab. If those same dollars were put into a direct reimbursement plan, you wouldn't lose benefits, but your employer would save money (unless he happened to save $88.56 per employee and decided you didn't need to make any contribution to the plan). Dartos > Please explain. All I know is it is a good deal for me. How can I > get 2 teeth cleanings and preventive works any cheaper than this? > > P.S. Bimonthly --> I mean 2x per month. I always confuse this term: > every other versus 2x/per? I'd bet a dollar to a pig turd that the insurance cost is way more than $88.56 per year. That means that the employer is picking up the rest of the tab. Reply. Yes, the employer IS picking up the rest of the tab. That is why it is called an employee benefit. If those same dollars were put into a direct reimbursement plan, you wouldn't lose benefits, but your employer would save money (unless he happened to save $88.56 per employee and decided you didn't need to make any contribution to the plan). Reply. Thanks. I still have to read through it thoroughly. BTW, we also have an account known as a flexible spending account (FSA). This may offset some of the costs that Medtronic pays for our ins benefits... but I am really not sure how all this works from the company's monetary standpoint. FSA (if an employee takes advantage of this benefit): We estimate how much we will be using in medical and dental benefits. We can contribute up to $5000/ year into an account (tax-free). If we overestimate and do not use all of the money that we had estimated, the unused portion goes back to Medtronic. I have never had this happen... I have always underestimated (made a conservative guess-ti-mate for the year). So for example, if I knew I needed 3 crowns placed.. I could put aside my portion of the estimated cost into this account (saving about 33% of this cost in tax dollars) I think this saves the company some money too. This reduces our monthly take home pay. Thus Medtronic can afford to reinvest this money as it pleases during the fiscal year.... Does this make sense? Sue >I'd bet a dollar to a pig turd that the insurance cost is way more >than $88.56 per year. That means that the employer is picking up >the rest of the tab. Hey! What a great way to get rid of those pig turds the trash guys won't touch! >If those same dollars were put into a direct reimbursement plan, >you wouldn't lose benefits, but your employer would save money [quoted text clipped - 8 lines] >> P.S. Bimonthly --> I mean 2x per month. I always confuse this term: >> every other versus 2x/per? >>I'd bet a dollar to a pig turd that the insurance cost is way more >>than $88.56 per year. That means that the employer is picking up [quoted text clipped - 4 lines] > What a great way to get rid of those pig turds the trash guys won't > touch! He wants them for his garden. 1 NTI = 500 lbs pig turds. You need to go visit Richmond. carabelli Just trying to keep the garden organic. Dartos > He wants them for his garden. 1 NTI = 500 lbs pig turds. You need to go > visit Richmond. > > carabelli > DR is a better deal for the employer and employee > > carabelli In a presentation a guy gave at a local dental society meeting he seemed to imply one of the best upsides for the dentist is there is no third party to approve or disprove treatment plans or to monitor what you are doing. For the honest dentist, this is great, on the other hand, I know of plenty of offices in my area who could use more people, not less, looking over their shoulder. I am not saying that we should make insurance companies the conscience of our profession, but having some practitioners feel that no one is watching what they do is a potential downside for patients/employees. T >I am not saying that we should make insurance companies the >conscience of our profession, but having some practitioners feel that no one >is watching what they do is a potential downside for patients/employees. If you make the DR a 50% reimbursement, the patient will monitor it for you. Amatus >> DR is a better deal for the employer and employee >> [quoted text clipped - 10 lines] > >T .. Amatus . > >I am not saying that we should make insurance companies the > >conscience of our profession, but having some practitioners feel that no one [quoted text clipped - 4 lines] > > Amatus Many dental plans pay crowns and such at 50% yet many offices simply waive the patient's 50%...(giving them a crown that is worth LESS than 50%...thereby proving the "you get what you pay for...sometimes less theory)...how will this practice miraculously end with DR? I don't mean to sound totally negative...as I do see some pluses with the DR type set up. As mentioned in another post I attended a lecture on the topic and was struck by the fact it was being pushed as something with no down side. I am just playing devil's advocate here. T This is a GREAT discussion. I must add however that some employers offer a great benefits package where the dental insurance is worth it if one takes advantage of it. Ex. I pay $3.69 bimonthly ($88.56/yr) for a Delta traditional plan. Having this insurance encourages me to keep up with my 6 month check-ups. If more work is required, I have additional coverage up to $5000. So for me this is defintiely a good deal. -Sue ____________________________________ Sue, I can tell you that you cannot get "traditional" Delta insurance for $89 a year. Somebody else (usually an employer) is paying HUNDREDS of dollars per year to Delta, in addition to your $89, in order to buy your insurance. Delta doesn't care who pays the money. All they care is that they get it. And boy oh boy, do they get it! (And keep a huge slice of it, too!) - dentaldoc >Ex. I pay $3.69 bimonthly ($88.56/yr) for a Delta traditional plan. >Having this insurance encourages me to keep up with my 6 month >check-ups. If more work is required, I have additional coverage up to >$5000. Sue... can you talk a little bit about the additional coverage Who offers it? --G Hi George. First let me correct this typo. The yearly coverage by Delta is only $1500. However I can take money out of my monthly paycheck at a rate of up to $5000/year. This is money that is not taxed that I can use for additional medical and/or dental costs not covered via insurance. This provides a savings to me of about 33%. I am sorry for that major typo!! As far as the cost of the insurance: I pay $88.56 per year for the insurance, the company pays the rest. It is a traditional plan where preventive is covered 100%, class II restorative 80% (I believe), crowns 50% (I believe) and so forth.... I hope this makes better sense. Sue >This is a GREAT discussion. I must add however that some employers >offer a great benefits package where the dental insurance is worth it [quoted text clipped - 6 lines] > >So for me this is defintiely a good deal. Yes, THAT IS a good deal! Mine on the other hand costs me $30/month with a max outpay of $1000. Note that this is a max. My wife will only probably get a couple "free" checkups and cleanings for her $360/year payment into the plan, so on her they are making money. Me, I may or may not use the $640 benefit, so the $30/month I'm paying into the plan may or may not be "worth it". Your $88.56/year (I see that you meant to say bi-weekly, not bi-monthly) is a great deal. But NOT, if like someone here said, (and I"m paraphrasing in my own words) your dentist acts like a used car salesman and talks you into treatments insurance doesn't cover that you don't need, in order to make money off you. You probably know enough about dentistry to know when you're being conned, but your average Joe does not and is inclined to trust the "good dentist". >>This is a GREAT discussion. I must add however that some employers >>offer a great benefits package where the dental insurance is worth it [quoted text clipped - 14 lines] >plan may or may not be "worth it". Your $88.56/year (I see that you >meant to say bi-weekly, not bi-monthly) is a great deal. Bi-monthly can mean twice a month or every two months. In this case it means the former. :-) HTH >But NOT, if like someone here said, (and I"m paraphrasing in my own >words) your dentist acts like a used car salesman and talks you into >treatments insurance doesn't cover that you don't need, in order to >make money off you. You probably know enough about dentistry to know >when you're being conned, but your average Joe does not and is >inclined to trust the "good dentist". Mine on the other hand costs me Jimsocal wrote: $30/month with a max outpay of $1000. Note that this is a max. My wife will only probably get a couple "free" checkups and cleanings for her $360/year payment into the plan, so on her they are making money. Me, I may or may not use the $640 benefit, so the $30/month I'm paying into the plan may or may not be "worth it". Reply. Jim, Sometimes dental ins plans do not make sense. Sometimes they are actually a rip-off for the patient. It sounds like this may be the case for you and your wife. You may be better off dropping your plans. Seriously. Let these dentists guide you. They will be honest with you. GOOD dentists goals' (like those here) are: #1- to convince you to get proper treatment and to accept their treatment decisions (doctor first) #2- to make a fair profit (businessman second) The ins companies' goals are (as I see it anyway..JMHO) are: #1- to make a fair profit #2- attempt to keep overall pricing down in the industry. #3- increase overall distribution of care (by keeping pricing reasonable, more care can to get to more people) In my estimation however, Goals #2 and #3 are becoming moot points in the U.S. because so many dentists are not buying into the insurance price capping attempts. My opinion may be slightly biased because I spent so much time on Dentaltown where this is what most dentists are trying to do---> go completely FFS (fee for service). (I do not know if this is the majority industry-wide however). *These are uneducated opinions only. I do not work for an ins company and I am not a dentist. *************************** Bottmline: Your dental insurance may not be a good deal for you, IMHO. You may be better off with no plan. **************************** I will let the doctors here carry the rest of this conversation re: dental insurance. Best of luck to you, Sue My attitude about dentistry is that the HMO plan can save you some money if you faithfully get your teeth cleanings and xrays done using the plan. BUT, like buyng a used car, you have to be wary and careful and not let them talk you into procedures you do not need. If they tell me "You need a deep cleaning", I'll get a 2nd opinion because I've already seen through that scam. If I get my teeth cleaned twice a year and floss and brush regularly, why should I need a "deep cleaning" at $100 instead of a regular ("Free") cleaning? I fell for this last time, but will not fall for it again. Basically, you HAVE to question what the Insurance dentist says and just get the basic "free" services. If he says you need something more than that, get a 2nd opinion, maybe at an FFS office. As to whether one gets one's money's worth with dental "insurance" it depends on where one lives, if it's PPO or HMO, how much one pays for the plan vs. how much benefit one will probably use, and being savvy enough not to let the dentist cheat you. It's a sad state of affairs, but now I will always see a dentist as someone who is very likely out to cheat me. Once burned, twice shy. Thrice burned, eternally shy. As to FFS dentists, I tried going that route once, with a dentist recommended by a friend. HIs fees were SOOO high that I could not bring myself to even get my full mouth xrays and cleaning there. If I can find one that has reasonable fees, I will try that route. > My attitude about dentistry is that the HMO plan can save you some > money if you faithfully get your teeth cleanings and x-rays done using [quoted text clipped - 4 lines] > year and floss and brush regularly, why should I need a "deep > cleaning" at $100 instead of a regular ("Free") cleaning? I would like to respectfully disagree with you. You will not save money with an HMO plan since any dental office participating will simply not provide the free services. These offices will never confirm your appointments in the hope you will simply forget (unless you are having "non-covered" procedures done). If they agree to schedule the "free" cleaning, it will be 4-7 months from now, and that slot will be double booked with something else. Of course, they are hoping you will forget you made the appointment by then. You need to get out of the mind-set that dental HMO works like medical HMO. It does NOT. Dental HMO is set up only to make the insurance carrier easy guaranteed money (no risk at all to the insurance carrier, as they simply keep a percentage of the premium regardless of how much the plan is used). Dental HMO has evolved into dental bait-and-switch. Every single dental office I have ever run across which does HMO work, is heavy into the bait-and-switch. They all tell me that they do NOT perform any covered procedures. Most even STOP doing amalgams in their office at all so that no one can complain that they are treating their HMO patients differently. You need to switch to a plan which cares if you get any care or not. Signature/ Amatus / > > My attitude about dentistry is that the HMO plan can save you some [quoted text clipped - 22 lines] > bring myself to even get my full mouth xrays and cleaning there. If I > can find one that has reasonable fees, I will try that route. >I would like to respectfully disagree with you. I respect your right to disagree. > You will not save money >with an HMO plan since any dental office participating will simply not [quoted text clipped - 4 lines] >booked with something else. Of course, they are hoping you will forget you >made the appointment by then. That has not been our experience. They have followed up and reminded us of our free cleanings. I think they are working off the "get them in here and charge them for something they don't need" model. >You need to get out of the mind-set that dental HMO works like medical HMO. >It does NOT. Dental HMO is set up only to make the insurance carrier easy [quoted text clipped - 6 lines] >procedures. Most even STOP doing amalgams in their office at all so that no >one can complain that they are treating their HMO patients differently. You might be right. But I thought they HAD to provide the covered procedure if you demand it. Again, it has been my experience that they just try to talk you into something you don't need, or "upgrade you" to uncovered materials, etc.. >You need to switch to a plan which cares if you get any care or not. On this you might be right. Like I said, IF I can find a good dentist not more than 10 miles from where I live (L.A. traffic is hell!), then I will try an FFS dentist. So far I have not found anyone that recommends their dentist except this one guy I know who pays his dentist Mercedes Benz prices for everything, which I cannot afford to do. They have followed up and reminded us of our free cleanings. I think they are working off the "get them in here and charge them for something they don't need" model. ____________________________ Bill's reply: That sounds very likely. They cannot make a living, or even pay the office help, with the paltry six bucks a month or so that the HMO forwards to them. _____________________________ But I thought they HAD to provide the covered procedure if you demand it. ______________________________ Bill's reply: Even if the HMO contract says they HAVE to provide it, they don't have to provide it! Here's why: No doctor, of any type, HAS to provide a service that he feels is not appropriate for the patient's health. If a dentist provides a service that he knows to be inappropriate, he would be guilty of malpractice. In order to avoid providing you with a free service, all the dentist has to do is state that he thinks it's inappropriate for your particular dental condition. Simple, eh? _____ On another note, since you already suspect that they're just trying to sell you something, why do you entrust your dental health to someone you don't trust? - dentaldoc > They have followed up and reminded > us of our free cleanings. I think they are working off the "get them [quoted text clipped - 33 lines] > > - dentaldoc Hi Bill, I just made the "open season" decision for my medical insurance and along with the package was the offering of "SmileSaver" at $8.00 USD per month. The "plan" (California Choice 1000 and 3000) isn't likely to be of any value to me with my special needs but as we know, I'm far from the average "dental patient". So many people opt in for these inexpensive plans thinking "how can I lose for eight bucks a month?" As many times as smd has discussed this issue, I'm always thinking there should be a warning to the public the reaches beyond our newsgroup. Take care, Webby >_____ > >On another note, since you already suspect that they're just trying to >sell you something, why do you entrust your dental health to someone >you don't trust? I trust them enough to do simple cleanings and xrays and fill cavities. If they say I need something more, I will get a 2nd opinion and perhaps have the work done with a FFS dentist. Problem is I cannot find an FFS dentist who is recommended and has reasonable prices in my area. So far I've been able to get simple things done under the insurance with this current dentist, and actually he seems like he is a good (technicallY dentist. It's just that he seems like a salesman and I don't fully trust him in that regard. IF I can find a reasonable FFS dentist I will stop subscribing to my Delta PMI plan. I am paying $35/month for my wife and I, which amounts to $210 each per year. Can we get full mouth xrays, and 2 cleanings for that price from an FFS dentist. Maybe some. But then if I need a root canal from an FFS dentist it will cost me $300-500 instead of the $50 here. If I need a simple filling, it will cost me $3. $100 for a crown - porcelain/ceramic. So the question is, can I TRUST this dentist to do good work? Well, so far I do have confidence in this one. He did a filling for me and I was very impressed with the painlessness. He's been doing it for 20 years and is a member of ADA and the state dental assoc.. I've been fooled before; but so far I think he's a pretty good dentist and the price with insurance is good. I just have to watch out for him charging me for things I don't need. Here's the Delta PMI price list for my plan: Preventative & Diagnostic (Not subject to deductibles) Oral Exams N/C X-rays N/C Prophylaxis (teeth cleaning 2 per calendar year) N/C Restorative Prosthetics Amalgam one surface, permanent (filling) $3.00 Crown-porcelain/ceramic $100.00 Denture-complete upper or lower $125.00 Bridge-porcelain fused to metal, per-unit $100.00 Endodontics - Root Canal Therapy One Canal $50.00 Two Canals $100.00 Apicoectomy $60.00 Periodontics Subgingival Curettage $15.00 Gingivectomy or Gingivoplasty, per quadrant $125.00 Orthodontics Startup Fee $350.00 Children $1,600.00 Adults $1,800.00 Some startup procedures may be covered under the preventative and diagnostic portion of this benefit. Monthly Rates through 12/2005 (Includes $1.00 administration fee) Single: $20.31 2-Party: $33.58 Member + Child(ren): $35.52 Family: $48.10 |
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