Saturday, February 18, 2012

Cut out the dental in$urance middleman

 I've written about my experiences with dentists in the US before. Dental care is big business in the US and competition must be fierce, as demonstrated by my recent visit.

My regular dentist is gentle fellow, wearing Hawaiian shirts and listening to KFOG. And he does great work. However, his schedule must leave him plenty of time to catch a few waves in the morning. Appointments are typically mid day and not on Monday or Friday.

With my busy schedule, I decided to try out a new dentist just around the corner from my home. I always see the lights on, several people in the chairs, even after 6pm and in the weekend. I got an appointment at 6:30pm for a cleaning. After the mandatory X-rays, a second set of regular pictures with a mouth camera were taken before they started scraping away any plaque. All was professional and went great. Since it was my first visit, they also explained how they handle my dental insurance (Delta Dental). This was a big surprise to me.

First of all, the dentist is out-of-network. (Why did I not check this?) But do not worry, the coverage is the same as in-network. Huh? Why even distinguish if the co-payment and coverage % are the same? But it gets better.

Because they do not want to deal with Delta Dental and all the paperwork, they will bill the insurance. However the insurance will send the cheque to me. All I have to do is to bring the cheque in. Easy, right? Let's get to the details:

  • No co-payment: although normally I have to pay a co-payment for in-network dentists, I do not have to pay this dentist any co-payment. 
  • Don't worry about the difference between what the dentist charges and what is the normally negotiated between the insurance and the dentist. If the dentist charges $2400 and the insurance considers a procedure should only cost $2000 and covers it at 100%, just bring the cheque for $2000. If the insurance only covers it at 80%, do not worry. Just bring in the cheque sent to me by the insurance and we're even. 
  • If the insurance denies the coverage, there is no cost to me at all. Just bring in the denial of coverage letter. The rational is that they will verity my coverage prior to the procedure and if a mistake is made, it is on them. 

It sounds all too good to be true. However, they have been in business for over 20 years, have a great deal of business with between 5-8 dentists on staff, and cosmetic dental surgeons visiting once of twice a week.

I figure their business model is all about volume. They don't deal with the insurance and save on the insurance fees and paperwork. Pass some of the savings on to the customers to make sure you have lots of clients to keep the big staff of dentists fully occupied. They basically take out the insurance middleman.