Dental Insurance for Out-Of-Network Providers

[ICACharleston]

I am happily paying $110 a month to MetLife for two of us, $3000 annual limit and my dentist is in the network and close by. Network discounts are substantial. We are both escaped dental patients and paying for the policy imposes a discipline to get regular care. It’s not all about the money.

as I’ve said before, dental insurance is a joke amongst agents. I advise my clients to floss.

 

[rousemark]

Manhattan Life. No network.

Caveat: most dental plans are a rip off for those who dont have regular dental issues. National average for a normal dental checkup is between $90-$120 depending on location. Often you can get a cash discount on that. Average price for a decent individual dental plan is around $30-$40. Even with an xray every 3 years, you are still just throwing away money.

All insurance is a rip off for those that do not have "regular" issues..

 

[LostDollar]

All insurance is a rip off for those that do not have "regular" issues..

@VolAgent once told me I could solve that problem by having an accident with each car I own, Have a tornado, having a heart attack and then dying.

 

[TRG1225]

Many clients in Florida want to go to dental offices that accept dental insurance but are not in-network. Are there any Florida dental PPO or Indemnity plans that are worth signing up for just to see out-of-network providers?

Who's network? Do you only have one carrier to offer? If you aren't captive to one carrier, then the best bet, IMO, is to call the dental office your potential client uses and ask what plan they take.

If you start to notice a common name popping up, I'd get contracted with them.

On the overall topic of dental insurance, I'm a bit against the norm in that I think it CAN be a good value, but there are a lot of disclaimers, checks and balances you have to put on it before you write it up.

 

[LostDollar]

Network discounts are substantial.

Yes. That ^

 

[LostDollar]

For example,

In Dec I had 5 fillings done at a retail cost of $1143. The BC network discount was $423. They then paid the provider 80% of the allowed amount (less my $50 deductible).

(and my "fan club" is telling me dental coverage is trash. )

 

[bmarsh]

With Manhattan, you have the option to use the Careington Max network for the discounts, and you don't have to wait for the reimbursements. Otherwise, you're free to go out of network.

 

[LostDollar]

With Manhattan, you have the option to use the Careington Max network for the discounts, and you don't have to wait for the reimbursements. Otherwise, you're free to go out of network.

(caveat, not an agent)

For my area, that would give Manhattan some points over Ameritas because the Careington Max includes Dentemax. Doing some provider lookups, I have seen several providers that don't take Ameritas (in-network) taking the Dentemax based coverage. (and apologies if I don't have the technical terms quite right.)

 

[vic120]

(caveat, not an agent)

For my area, that would give Manhattan some points over Ameritas because the Careington Max includes Dentemax. Doing some provider lookups, I have seen several providers that don't take Ameritas (in-network) taking the Dentemax based coverage. (and apologies if I don't have the technical terms quite right.)

I used an ameritas company for a short while before I found Manhatten, I had lots of CS issues bills disputes and such

Now I dont know if all that has changed since then They have added no wait periods for the previous cov and such

They didn't pay well either

Since using Manhatten I have had a ton fewer CS issues very few in fact

They pay better

Also don't think there are any plans that much better to consider from what I have seen I might sell a lower commission if it were a big difference but there is not enough difference to get paid less

I take this attitude tell people dental is not always a good buy if they want preventative mainly occasional; filling I suggest the second to lowest Delta premium

If they want more ill sell the manhattan

I don't push and I don't chase it, It is just take it or leave I don't waste time

 

[LostDollar]

I used an ameritas company for a short while before I found Manhatten, I had lots of CS issues bills disputes and such

Now I dont know if all that has changed since then They have added no wait periods for the previous cov and such

They didn't pay well either

Since using Manhatten I have had a ton fewer CS issues very few in fact

They pay better

Also don't think there are any plans that much better to consider from what I have seen I might sell a lower commission if it were a big difference but there is not enough difference to get paid less

I take this attitude tell people dental is not always a good buy if they want preventative mainly occasional; filling I suggest the second to lowest Delta premium

If they want more ill sell the manhattan

I don't push and I don't chase it, It is just take it or leave I don't waste time

Hey Vic, thanks for those comments.

I agree with your second to lowest Delta comment.

I just took on Delta as a third dental plan option. I went with their 3rd level plan because of the possible level of my financial need, I wanted the $1,500 benefit. Since I can't buy a policy and have coverage after a treatment is started, I just had to guess. I am going to max out my primary and secondary plans again this year. In a best case scenario, I would have been better off just paying cash for a few services after the plans ran out. In my guess at a worst case scenario I could have an additional $3-$4k (at retail) of uncovered service charges for 2021. If that happens, Delta will get me a good network discount and give me payment help on the allowed amounts.

That gives me UHC, BC and Delta for current dental coverage. They each have good points and not so good points. My plan right now is to try to assess my dental health in 12 months, hoping I can drop one plan, and then again in 24 months hoping I can drop another plan and be back to just one.

If other states Delta plans work like Kansas' does, one thing that ought to be nice for at least some of your prospects is that they Delta (in KS anyway) will waive waiting periods with proof of prior coverage in the last 60 days.

(My case study: I have had a UHC plan (that includes coverage for major services) for 3 years. I added BCBSKS in Dec 2020. I documented for them that I had had 12 months of coverage, including coverage for major service, just prior to my app for BC coverage. BC waived their major services waiting period for me.

That was Dec 2020. Then in Feb 2021 I applied for Delta coverage effective March 1. They just wanted me to have had Dental coverage in the prior 60 days. So I gave Delta the BC info (for the plan I had only had since Dec) and they waived their waiting periods for me based on that.)

One caveat there, BC sent me paperwork showing the waiting periods have been waived. With Delta I have no paperwork, only CSR statements. I am going to have my dentist run a predetermination with Delta to verify that the waiting periods are in fact gone.

(And I have also done the dual coverage paperwork for Delta showing them both my UHC plan and BC plan.)

I am not willing to make a final commitment at this point, but there is a good chance I will choose that second level Delta plan as my final option if I can get back to one plan.

Anyway, I appreciate your comments.