I’ve never been enthusiastic about HMO’s, and have been able to avoid them so far. But now my son who lives in New York City, apparently needs a crown. He has Delta Dental Basic PPO insurance, which seems to cover everything EXCEPT crowns, which is really annoying! He can upgrade his insurance, but crowns won’t be covered for a year.
So…Delta Dental says they have an HMO that is pretty inexpensive, that covers crowns right now, no waiting period. Really, it seems like too good a deal to be true. And maybe it is. When I look at the dentists in their networks, they are all rated really low(by Yelp) . I know people can mess around with those ratings, but it makes me wonder if the only dentists willing to go into those HMO’s where they aren’t paid for services too highly, are those who are new in the business, or who can’t get/keep clients.
Hmm, I don’t know if you can search out specific dentists on Healthgrades. And many of the highly rated dentists only have 1-3 reviews, which seems a little sketchy to me. Also, Delta Dental isn’t listed as an insurance I can make a search by. Grrr! I wish this was easier.
Tell the truth, I’m kind of uncomfortable by the dentist telling him he needed a crown. This is a new dentist. Charged $975 just to fill two small cavities, which seems really expensive. I have been to dentists before who have recommended a crazy amount of work…and the second opinion recommended very little. So maybe a second opinion is in order, first.
It is really expensive. Even at the high end of the price ranges for 1-surface fillings suggested at the links below, the cost should be considerably less than $975 (New York, NY, 1-surface filling, metallic and white).
The same site suggests that a fair price for a crown is about $1,000, with a high end price of around $2,000.
Probably laboring under a few hundred thousand dollars of dental school debt, plus whatever it costs to start up a new practice or buy an existing one from a retiring dentist. Perhaps it should not be surprising if dentists under financial pressure tend to be expensive and have bias toward recommending dental work in marginal cases.
I have discovered that some dental insurances max out for the year at very low amounts (my daughter’s plan through her employer maxes out at $1,250, mine never did, so I didn’t even consider this) I feel like a crown is something that is important to be done properly. I try to get dentist recommendations from another dentist I trust (they frequently know people in other areas of the country).
I put my zip code into fair price and got the same range of fees for my small Midwest town. Not sure I would make a decision based on this.
FWIW, I had a young patient who lived in NYC whose parents paid for her to come back and see me. It was cheaper for them to fly her back if she needed a cleaning and some fillings. NYC fees tend to be some of the highest in the country.
I asked my dentist awhile ago if he knew anyone in NYC, and he said no, but I’ll ask again. We had just scheduled dental cleanings for when our son was in town, but then it became difficult flying all the way across the country for that. It looks like $975 for two small cavities is really expensive, even for NYC. The plan only covers 50% of the fillings…yet they charged him $243 copay. I don’t understand that one, no idea how the billing is working.
I think what we will do is try to get a second opinion, and if he needs a crown, either wait till he comes home for Christmas (if he can wait that long), or get the second dentist to do it. I can’t imagine how much someone would charge for a crown if they charge $500 for a filling!
The dental HMO thing just doesn’t sound like the best idea…I think I’m going to call our local dentist and maybe they can get the x-rays sent to them to take a look. His local dentist had said it needed to be a crown because it’s a cavity in the very back of his mouth that is hard to get to. Is that a good reason for a crown?
My son went for a routine 6 month cleaning with a new dentist…part of one of those large groups. They gave him a laundry list of things he needed to get done, including a crown.
I need to add…this kid has never had dental issues in the past.
I told him it was cheaper to go to a private practice dentist and get a second opinion…which he did. Remarkably, the second dentist didn’t recommend ANY of the things frommthe large group place.
This sounds similar to a situation our daughter had. Our dentist told her she needed a crown because she had two filling in that tooth. She did have pain in that tooth, but we thought his reasoning didn’t merit a crown, especially at her age. And all her other teeth are in excellent shape.
The crown was a continuous battle with each six month checkup for about 2-3 years. Then he told her there were two cavities that needed to be filled. We were shocked! How was she getting these cavities?
Because she was staying at school over the summer, she didn’t have the liberty to schedule an appointment with him, but found a dentist at school who would do it if our dentist sent the x-rays to him. Well! Turns out the two cavities were under the original two fillings because they weren’t filled properly! No wonder she had pain!
Those dental HMO’s give very low cost or free cleanings so they try to sell you a bunch of other stuff you might or might not need to make money. I dumped my DHMO and went back to PPO, don’t feel like going to a used car salesman every time I went to the dentist. However if you can stomach the sales pitch, you can get very low rates if you just need cleanings every 6 months, and if you really do need something they do cover about the same percentage (sometimes higher) as a PPO.
Check the fine print as to Delta Dental HMO as to “covers crowns right now…”, I’ve seen wording that says something like, if the problem can be fixed with a big filling, then that’s the covered benefit, a crown then would become an optional benefit and not covered under the plan.
This is what the Delta Dental rep said. He was really trying to push the HMO.
Believe me, if my son could just get a big filling instead of a crown, he’d do it in a minute. The dental office is saying he needs a crown, so I’m assuming they would claim that in the insurance filing. However, they are not an HMO, so they wouldn’t be filing for insurance for it anyways, it would be someone else.
Yikes, @CU123, that doesn’t sound good. I don’t want my son to get a sales pitch from an HMO every time he just goes in to get a cleaning. He gets free cleanings with his current plan. It’s very difficult for an older adult to filter through what they actually need from a dentist they don’t know, much less a young adult! And my son has had plenty of cavities, so he probably needs something more than just cleanings.