Dissatisfied with her dental insurance coverage, Patricia Torres, left,… (Cheryl A. Guerrero, Los…)
When Patricia Torres learned she needed a root canal, she wasn't concerned. After all, she had dental insurance. Then the bill arrived.
"I was completely shocked and surprised because the bill came in for $750," says the 38-year-old stay-at-home mother from Woodland Hills. Her insurance covered only 50% of the price.
Torres' surprise at the size of her bill didn't surprise Jeff Album, vice president of public and government affairs with Delta Dental of California, which sells dental benefits. "The average person doesn't know how dental insurance works and shows up at the doctor's office and discovers that with advanced treatment, there is a cost to bear."
Dental insurance differs from medical benefits in a number of ways, he said.
First, it's specifically designed to encourage preventive treatment. That's why most dental plans pay 100% for preventive services, such as cleanings, X-rays and checkups. Basic restorative services such as fillings and periodontal cleanings are generally covered at 80%, and you'll commonly get just 50% reimbursement for procedures such as implants and crowns.
In addition, they commonly come with low annual maximums that place a cap on what the plan pays toward care — the typical range is $1,000 to $1,500.
Even with coverage, the high cost of dental procedures prevents many people from seeking care. In a recent study of Los Angeles residents conducted by Empirica Research, 51% with dental insurance say they've delayed care because of cost. That number jumps to 68% among those without coverage.
As with all types of healthcare, experts say that by taking the time to understand available options people can cut down on costs to help pay for the dental care they need.
•Search for discounts. Discount dental plans are plentiful, says Evelyn Ireland, executive director of the National Assn. of Dental Plans, which represents the interests of the dental benefits industry.
But these are not insurance plans, she was quick to point out. "It's a buyers club and a discount system, but you still have to pay the full amount of your care out of pocket."
To get the reduced negotiated rate you must go to a network dentist. Discounts range from 10% to 60% off common charges. "The consumer pays in full, but the positive is the discount can be lower" than with insurance, Ireland says.
After receiving the bill for her root canal, Torres searched for an alternative to dental insurance, for which she was paying $1,200 per year for both her and her husband. "When the policy was up, I went online to compare and see what else is out there."
She found a new Los Angeles-based service called Brighter.com, which has a network of 500 dentists offering discounts on roughly 300 dental procedures. Torres did the math: "If I used Brighter.com I could have avoided paying the insurance premium of $600 per year, and for the cleanings would have paid the discounted rate of about $250 to the dentist directly for the same services. So I would have saved about $350 each year."
The service is free and allows you to book appointments online. "The reason it works is because … in our model the patient pays the dentist directly," says Jake Winebaum, Brighter.com's founder. In addition, he says, it creates a marketplace in which consumers benefit from competition. "For the first time dentists can see what their competitors are pricing," he says.
According to Winebaum, consumers save an average of 50% on dental costs through the site.
•Consider an HMO. Dental HMO plans require you to see a dentist in the insurer's network. HMOs may be a better deal for some people than PPO plans, which allow greater flexibility, experts say.
The monthly premiums are lower, and office visits require only a co-pay, generally $5 to $10. Unlike in a PPO plan, there is no annual maximum limit on coverage. "If you're concerned about needing a lot of care, then an HMO is a good solution," Ireland says.
Album with Delta Dental acknowledges, however, that there are downsides to HMOs: Your preferred dentist probably will not be part of the group, and the office environment tends to be corporate in feel, with a number of dentists all working for an entrepreneur.
The chairs are often full, and you're likely to wait to see the dentist. "It may not be the most personable experience, but the care is quality care and it's less expensive," Album says.
•Compare prices. It's always a good idea to shop around. Ask about cost upfront by requesting a pre-treatment estimate and then do some comparison shopping before proceeding.