PDA

View Full Version : I need some directions.



Rich Engelhardt
05-21-2014, 11:46 AM
I'm trying to locate the place that insurance companies always refer to where their charges are "usual and customary".

My wife has to have a tooth removed and a partial bridge put in.
The total bill is going to be around $4900.00.

The insurance company says the "usual and customary" charges are $700.00, so they are going to pay 80% of $700.00 - minus the $500.00 deductible that has to be met of course.

Anybody know where this place is located?

Jim Rimmer
05-21-2014, 12:53 PM
Check this link: http://en.wikipedia.org/wiki/Resource-based_relative_value_scale
Google Resoanble and Customary Dental Fees and you'll get 500,000 hits.

Brian W Smith
05-21-2014, 2:08 PM
Well it sure as heck ain't here at our place,haha.After payin umpteen thousands in home owners premiums,we had one bloomin claim in 30 or so years.Their(State Farm)expert estimation was about 10 or so percent of the parts bill.A lightning bolt blew a trashcan sized hole in our roof.........and will spare the details,but suffice it to say,a 40' ladder wouldn't reach the problem(standing seam terne metal,finished 4th fl attic space,ad infinitum) ....duh.

I went all the way to the top,to include the insurance board......it was a complete farce,ended up telling them to shove it,and would tell everyone that would listen how BAD their co represents itself.

Andrew Pitonyak
05-21-2014, 2:18 PM
A root canal or a crown is in the $1000 range. This site seems to agree with them, however:

https://www.guardiananytime.com/dceapp/DentalCostEstimatorWeb/dentalCostEstimator.process

That page seems to agree for a partial as under $1000. What else will they be doing.

I assume, however, that this quote is for more than just installing the bridge.

Scott Donley
05-21-2014, 2:43 PM
I am in the middle of having an implant done with bone graft, 5,500 A bridge was going to be 6,300. Did I say , I hate the dentist .

David Weaver
05-21-2014, 3:19 PM
I'm trying to locate the place that insurance companies always refer to where their charges are "usual and customary".

My wife has to have a tooth removed and a partial bridge put in.
The total bill is going to be around $4900.00.

The insurance company says the "usual and customary" charges are $700.00, so they are going to pay 80% of $700.00 - minus the $500.00 deductible that has to be met of course.

Anybody know where this place is located?

I think your problem is with the dentist and not the insurer.

Mike Wilkins
05-21-2014, 3:20 PM
You can take pleasure in knowing you are assisting the dentist in working a 4 day workweek, his BMW payments and the beach house.
I remember talking with an attorney when making a real estate transaction, telling him that our daughter was wanting to be an attormey. He said talk her out of it and tell her to go to dental school. That should tell you something there.

Rich Engelhardt
05-21-2014, 3:42 PM
I think your problem is with the dentist and not the insurer.There's a conspiracy afoot in our part of the country then because every time we get prices for any type of medical procedure, they are always five to seven times more than what the insurance company deems "usual and customary".

Jay Jolliffe
05-21-2014, 4:04 PM
I picked up a prescription at Rite Aid & it had the U&C cost on the paper work that came with it along with all the side effects that scare the **** out of you. Well I paid 20.00 & the U&C was 450.00.....How do they figure that.

David Weaver
05-21-2014, 4:50 PM
There's a conspiracy afoot in our part of the country then because every time we get prices for any type of medical procedure, they are always five to seven times more than what the insurance company deems "usual and customary".

It's always like that. I got a crown a couple of years ago, and the dentist's office had an agreement with the insurer that the root canal and crown all total would be about $700. I had to pay half of it. The insurer paid the other half. Cash price was $3,000.

What's odd to me is that when your insurer has a customary charge, the dentists office isn't required to stick to a negotiated total price. If I were in your shoes, I'd switch coverage if possible to one where those high dollar services were already negotiated.

When you go into a dentists office for a non-routine service and you don't have a pre-set limit and haven't negotiated on your own behalf or shopped around, then you're really their target to make up all of the losses they feel they've incurred on negotiated services.

So, anyway, I think your issue is with the dentist and not the insurer.

George Bokros
05-21-2014, 5:00 PM
I am retired so I have no dental insurance. I broke a tooth so I needed an implant to replace it. Dentist quoted me ~$4900. His financial manager suggested that I take out some dental insurance that provides discounts to policy holders. I checked it out and got a policy that was effective immediately for $159 for 15 months coverage and then my cost for my implant dropped to ~$2200.

Not a bad return on a $159 investment.

George

David Weaver
05-21-2014, 5:19 PM
At any rate, the advice is to negotiate the price or change coverage or dentists before the procedure, because once you're done, they often won't do anything because you've already agreed to the charge.

Your lesson could save some of the other folks here some money.

Ken Fitzgerald
05-21-2014, 5:44 PM
I could buy a new car for what I have invested out of pocket in periodontal treatments, bone grafts and implants in my mouth. Bad genetics coupled with being a 1 1/2 pack a day smoker for 41 years gave me a close relationship with my family dentist and periodontist. Most of it wasn't covered by insurance at the time. In one 12 month period alone, it cost me out of pocket over $16,000 for treatments to my lower jaw. Though I have dental insurance, the insurance was no help for these treatments.

I could have chosen less expensive methods of treatments but I didn't.

And yet.... Let's see........ You are 19, graduating from HS......you're a good student......you go to college and get a pre-medical or pre-dental 4 year undergraduate diploma.....then 4 years of dental school..... You are now age 27 and according to this website http://www.asdanet.org/debt.aspx 75% of all dental school graduates are at least $100,000 in student debts and over 50% have $241,000 in student debt.......now you decide on a specialty that requires 4-6 years of graduate school and residency so you are now nearing your mid-30's and it's not unusual for these folks to have $160,000-to-over $300,000 in student loans....you still have take and pass a stiff licensing exam and then become board certified. BTW, the exams can cost you a couple thousand just take and pass. Finally, after all this, you can start earning an income and paying off those debts.


BTW...my youngest son graduated from dental school a little over a year ago. He practices in the US Navy.

Larry Klaaren
05-26-2014, 12:10 AM
Same thing in veterinary medicine. People think you are making a big salary, but after schooling costs, overhead, malpractice and such, you just aren't. It's also an issue that you went without an income for 7+ years to get the schooling.

Bill ThompsonNM
05-26-2014, 1:18 AM
Same thing in veterinary medicine. People think you are making a big salary, but after schooling costs, overhead, malpractice and such, you just aren't. It's also an issue that you went without an income for 7+ years to get the schooling.
+1. To that. Should be obvious though, I drive a 1982 vw diesel pickup. Need I say more. Bill Thompson, DVM