ljmydayaway (ljmydayaway) wrote in bad_service,

Am I getting screwed here?

So, this is my first foray into having and using dental insurance. I have a DMO plan and have a dentist in the network. Posting this in Bad_Service for advice, but also because the dentist might be giving me bad service due to how she's charging me. Delete it if you think it's off topic, or I'll delete it later, or whatev.

I went in today to ask about getting a nightguard and asked how much it was going to be. She looked at my insurance papers, and said "Well, your insurance would cover 50%, but it would be really expensive. Instead, we charge you on a 'fee schedule.' It would be $450."

First off, that's $200 more than it cost me to get a nightguard in a state known for being extremely expensive, less than 3 years ago. I didn't have insurance then.

Second, if they WERE following what my insurance covers, then that would mean it costs $900 without insurance. I am EXTREMELY doubtful that a little bit of molded plastic costs that much.

She says that if I had a PPO, they'd be charging me almost nothing, because the PPO "actually pays us." However, the reason I got the DMO was because the coverage (so long as you went to an in-network dentist) was supposed to be way better, according to the papers (better coverage, lower deductible, and no max on benefits).

I already had her give me a tooth cleaning. It was $200 for a "deep cleaning." I used to pay $200 without insurance for the same cleaning, but it included the cost of X-rays too. This one did not. I was only supposed to pay 20% of the cost of the cleanings, according to my insurance. (I actually just checked my papers. Preventative maintenance, aka cleanings, is meant to be covered 100%. The next step is "basic maintenance", covered 80%, and then "major maintenance", covered 50%.) So this.. just sounds completely insane. (I didn't bring it up last time because, honestly, I'm new to insurance and thought maybe they didn't cover the "deep cleaning" or something.)

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