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Thread: Dentist - (w/ insurance) recommendation

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    Forum Regular - Vociferous Class Lupechennel's Avatar
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    Question Dentist - (w/ insurance) recommendation

    I FINALLY have dental insurance. I may have to switch dentists as it may be significant $$ savings. Anyone have experience with Metlife - the + one (PPO/PDP)? Any local guys that can be recommended? I have the listing/provider directory but of course I know nothing of these dentists.

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    Forum All Star DTM's Avatar
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    I believe Dr. Petrelli is in there. We had her for years.....

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    I have MetLife but my firm offers two options with dental - we can use out of network dentists with just a bit more co-payment. In my case, I like it because I kept my old dentist in Elmhurst, but still get material assistance toward work done there.

    I will say that MetLife processes claims extremely quickly, although my dental office has people who basically just deal with insurance carriers, so that may help as well.

    Good luck - hope you find a great provider and have good luck with the coverage.

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    Forum Regular - Vociferous Class Lupechennel's Avatar
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    What i'm confused about and I may have to shoot an email or call over to Met -if I change and go to an in-network provider, that that mean the doctor takes the amount of insurance paid? I got the impression big things only are covered 50% but I'm seeing something different in my plan book. My dentist -who doesn't take the insurance/isn't a network provider, stated that the process will be covered 50% up to $1,500 per year. I think I can probably get a better deal if I switch - like a few hundred or more $$, or is it not worth it? The route cleanings I don't think apply to the $1500 or in my case- in network $1,750.00 per year. That's included. I think I'll have to make some calls. I'm trying to not switch but if the savings are hundreds - to may be over a grand, it may be worth it.

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    Quote Originally Posted by Lupechennel View Post
    What i'm confused about and I may have to shoot an email or call over to Met -if I change and go to an in-network provider, that that mean the doctor takes the amount of insurance paid? I got the impression big things only are covered 50% but I'm seeing something different in my plan book. My dentist -who doesn't take the insurance/isn't a network provider, stated that the process will be covered 50% up to $1,500 per year. I think I can probably get a better deal if I switch - like a few hundred or more $$, or is it not worth it? The route cleanings I don't think apply to the $1500 or in my case- in network $1,750.00 per year. That's included. I think I'll have to make some calls. I'm trying to not switch but if the savings are hundreds - to may be over a grand, it may be worth it.
    I would call MetLife and also, if your dentist has a insurance person, and talk to them to get a feel for what would be reimbursed either way. Each employer can tailor their insurance coverage with a provider differently, so mine may be somewhat different than yours. It's really so subjective. I've gone to my practice for close to 40 years (obviously different dentists along the way) and really like them so 'leaving some money' on the table isn't quite as critical to me; I'm also single so only worried about my own teeth. I do have a deductible on procedures other than cleanings with my non-network dentist, but it's $50. To make things even more fun, my employer self-insures. Not sure the impact on dental insurance of that choice.

    I would say generally you get more in benefits if you go with the network provider; I was just pleased that in my case the difference wasn't so dramatic that I felt I had to change. And I have terrible teeth. This year alone I got a new crown and a filling. It still hurt the pocketbook. Dental insurance, IMO, in general hasn't really kept up with actual dentistry.

    Slightly funny story. At one point, my employer offered some coverage toward braces REGARDLESS OF INSURED'S AGE. So, half the workforce apparently decided to get braces (I did!). About three years later, orthodontia was restricted to children (unless it was part of a medical procedure, like after an accident).

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    Forum Regular - Vociferous Class Lupechennel's Avatar
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    the dentist staff was able to pull up my policy. It is indeed not covered as well as in -network. Also I'm able to do a 'mock' online estimate with the insurance - which isn't even close in prices I feel but still helps with the math. And I'm able to get a better feel for what is covered and not on their website, which was a nice find a few minutes ago. Certain procedures and services are once every 5 years, yikes! Not good. I guess most people have to get carecredit I suppose.

    POST SCRIPT -I think it's 'per tooth' every 5 years. So if 2 different teeth needed something -it may have some coverage.
    Last edited by Lupechennel; 10-03-2017 at 05:12 PM. Reason: PS

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    Quote Originally Posted by Lupechennel View Post
    the dentist staff was able to pull up my policy. It is indeed not covered as well as in -network. Also I'm able to do a 'mock' online estimate with the insurance - which isn't even close in prices I feel but still helps with the math. And I'm able to get a better feel for what is covered and not on their website, which was a nice find a few minutes ago. Certain procedures and services are once every 5 years, yikes! Not good. I guess most people have to get carecredit I suppose.

    POST SCRIPT -I think it's 'per tooth' every 5 years. So if 2 different teeth needed something -it may have some coverage.
    I'm guessing it's more per tooth for certain procedures. Crowns, for example, usually need to last five years before insurance will cover a replacement crown. All of mine have gone well beyond 10 years (yep, bad teeth,, what can I tell you). Pretty standard you should be getting two cleanings a year, though?

    In my experience, and I will admit I have good health insurance, dental insurance isn't really as comprehensive as a medical plan, and you can run into that 1500 or whatever max fairly quickly in a bad year. Let's say a person needed two crowns, or maybe an implant or a bridge. On the other hand, even I have gone for ten or more years in a row without anything more than cleanings and an x-ray. And, when faced with an implant, anything the insurance will cover is helpful ;-)

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