r/DentalInsurance

The dentist did not obtain a pre authorization and submitted a letter stating that the procedure was necessary and submitted x-rays as well. The insurance company denied the claim. I appealed it. The dentist did not.

I’m just a patient - this involved a ‘three surface’ filling (whatever that is). As a patient, there is no way I would know what is or is not necessary. I’m just sitting in the dentist’s chair thinking he’s just giving me a basic filling.

The dentist did not appeal the denial but I did, though what more could I say other than see the dentist’s letter and the x-rays. The dentist is not exactly friendly and so I feel like he may have just done a procedure I didn’t need.

This doesn’t seem fair to me as I’m the o e who would’ve on the hook for this ‘necessary’ or ‘unnecessary’ procedure. What recourse do I have?

The insurer is GEHA.

Thanks

I currently have no dental insurance but I have bad gums and tartar so I go to the dentist every 3 to 4 months or so for a necessary cleaning. The only other current dental issue I have is a potential replacement on my crown that I’ve had since childhood (1 was replaced 2 years ago so the other will probably break soon).

I’ve looked into insurance options but everything affordable I found didn’t cover that many cleanings per year and most didn’t cover much in the way of “cosmetic” crown repairs. (Dental through my work doesn’t cover any of that.)

Are there actual options for that care that will save me the out of pocket hundreds I spend every year?

so why does dental insurance only cover to like $2000 a year total?

why can;t you get more, by paying more in premiums>?

seems like that would be an obvious winner for insurance companies..

Just found out I have effectively no coverage even though I have been paying every paycheck since February. I selected a dental office about 10 miles from my home when I filled out my new employee paperwork back in January. Welp, today I lost a crown. So I called the dentist office that I chose. They have no record of my insurance. So I double checked with my benefits coordinator, and she showed me the paperwork that she submitted to Guardian with the ID number of my chosen dentist. I called Guardian and it turns out that they randomly assigned me to some dentist I have never heard of, two hours away, for no reason. They said they can change me back to the dentist I chose, but it won’t be until at least June. I tried talking to a supervisor, and even sent copies of the original paperwork from my Benefits Coordinator, but they are unwilling to budge. What can I do? I am in pain.

My previous dental office would send the claim on the day of or a day after the procedure. Was my previous dental office just fast or is that how things are normally done?

Anyone have experience with delta dental for ortho for a teen out of network do they pay the claim, my insurance pay 2000 life time with 50 percent.

We want to drop Delta of WA. I am hearing they make it impossible!!! My friend was in tears about what happened to them when they left. Is this a bad idea? Is it really optional? I have so many questions

What % of patients did you lose in the first 1–3 months? How long did it take to recover (if you did)? Do they send letters?

Are you willing to share actual numbers and communication they are sending out?

If participation were truly voluntary… could dental practices leave a major PPO without taking an immediate financial hit?

Have you ever tried to call an insurance company and they seem so incredibly inept? They don’t have the right information. They do t have access to the right information. They can’t guarantee that the information is correct in all systems. The phone tree is never ending. No one answers the phone. When they do they hang up on you.

I just spend an hour on hold with MetLife with no answer. I’m an out of network provider and they paid me as an in network provider…last year for several claims. My staff have spend hours on the phone, have reference numbers, have talked to multiple people, all to no avail.

So are they inept? Can they really be this bad? I say no. And we all know it. If it’s not them being totally incompetent, then it’s by design. They do this on purpose. They make as close to impossible as they can to deal with them. They suck our time, our happiness, our life. And they do it on purpose. This my title. They are evil.

How have we let them get so big and powerful. Who can stop this? Is it hopeless?

looking for a good oral surgeon to get wisdom teeth removed. i have dental dental silver. not from the area so it’s been tough finding dental providers. my partner has only two wisdom teeth needing to be removed. hopefully somewhere not too expensive. lmk! thank you!

I’m in Georgia and need 4 cavity fillings + a wisdom tooth extraction coming up.

I compared plans:

• UnitedHealthcare Solstice (discount plan): ~$480 for fillings
• UnitedHealthcare PPO: ~$600+ for same work

My dentist is suggesting a “DPO” plan (I think DHMO) from Cigna / Delta Dental / Aetna, saying it would be cheaper.

But when I compare breakdowns, the out-of-pocket difference is tiny (like $5–$10), even though the allowed amounts and insurance payments change.

So I’m confused:

• PPO = higher monthly but more flexibility
• DHMO/DPO = lower monthly but more restrictions
• But total cost for me looks almost the same either way

I also have wisdom teeth removal coming up, so I want the best option overall, 

any advice on what to do or where to go

Trying to choose between a DHMO vs PPO dental plan and would love some real-world input.

From what I’ve gathered:

•	PPO = more flexibility in choosing dentists

•	DHMO = cheaper premiums, but more limited network

•	DHMO seems fine for basic stuff, but PPO might be better for bigger procedures

I’m currently leaning DHMO for the lower premiums, but a bit worried about being locked into a bad provider.

Questions:

•	If you have a DHMO, do you feel limited when you need more than just cleanings?

•	Anyone regret going DHMO vs PPO (or vice versa)?

•	Any SF dentists you love (or would avoid), especially within DHMO networks?

Feels like the actual dentist matters more than the plan, so referrals would be huge!

Im in Texas and my current job will not offer Dental. I need something quick for cleanings and cavities for my kid. Thx.

I seen a regular dentist and she told me I need to see a periodontist because she thinks I have gum disease. She said that I needed to see a periodontist because they can clean under the gums and give antibiotics, and to help save my teeth.

I went to a periodontist and had half my mouth deep cleaned. He verified I do have gum disease and I need my mouth deep cleaned and even talked about oral surgery eventually. Now my insurance will not approve for the other half of mouth mouth to get deep cleaned because I have to wait till 12/31/2026. I've called my insurance delta dental for the 4th time today and just filled out a grievance form. Am I wasting my time with them? I read after I can file an appeal if declined, but I want to at least get the other half my mouth deep cleaned before 9 months. I found a discount savings plan I would have to payout about $800 just to get it done with no waiting period. Any advice on what I should do?

This is a dental practice and dental insurance question. I was told by an IN-NETWORK dentist that I need two crowns. I requested a pre-determination estimate of costs associated with both crowns. It took a long while, but I finally got an estimate. The dentist used code D2740 for both crowns themselves, then additional D2950 for "crown buildup w/pins" for both, and then additional D4249 for "crown lengthening" again on both. The insurance only approved the two "crowns" (D2740), one of the "buildups" (D2950), and denied both "crown lengthenings" (D4249). I asked the office to resubmit with medical justification so that my insurance will cover. My insurance will cover 60% of a crown. I have waited weeks to resolve this and then learned they did not even do the resubmission. So I asked again for them to do it, and still wait. Why is the crown submission (D2740) not inclusive of the other two procedures? How do I get this resolved? I can not pay thousands of dollars. With the way the matter stands on the current estimate, my bill will be nearly $4000 AFTER any insurance payments based on how they are billing for just two crowns! Without any insurance covering any of it, the cost is estimated at $7576. One of the teeth has never even had a filling, but the dentist wants to do crowns because the decay is close to the gumline or root, I guess, on both. I do not know how to question this to get my crown covered at 60%. Please, help!