MAPD Dental Benefits

[policy doctor]

Is anyone else experiencing problems with dental coverage by their mapd carriers or am I just lucky? (sarcasm) St Patty's coming upl

Cigna-Healthspring hmo uses Delta Dental for their add-on dental plan...premium runs about $17/mo and covers all different services up to $1500 max. So my client finds a dentist in the directory who when they show up denies the dental service because Delta tells DR they are NOT in network on that plan, but a Cigna corporate plan. So this goes around for several rounds with CSR in Cigna until I tell client to disenroll from the dental plan. This was their second dr.

Found out later at a Cigna mtg they are having problems with the vendor.l

OK...now we have CIP. Preventive is only $20 copay for visit, xray and cleaning whether in or out of network. Bill is $279...after 2 months of wrangling between CSR and dental office and a mad client...I and client finds out today she will receive $49 in benefits to Dentist and balance is hers.

 

[Nikita]

Is anyone else experiencing problems with dental coverage by their mapd carriers or am I just lucky? (sarcasm) St Patty's coming upl

Cigna-Healthspring hmo uses Delta Dental for their add-on dental plan...premium runs about $17/mo and covers all different services up to $1500 max. So my client finds a dentist in the directory who when they show up denies the dental service because Delta tells DR they are NOT in network on that plan, but a Cigna corporate plan. So this goes around for several rounds with CSR in Cigna until I tell client to disenroll from the dental plan. This was their second dr.

Found out later at a Cigna mtg they are having problems with the vendor.l

OK...now we have CIP. Preventive is only $20 copay for visit, xray and cleaning whether in or out of network. Bill is $279...after 2 months of wrangling between CSR and dental office and a mad client...I and client finds out today she will receive $49 in benefits to Dentist and balance is hers.

Ohhh....be very very wary of that CIP dental benefit. In my opinion, it is very misleading. The $20 cleaning only works if the dentist is in network, even though in the plan brochure it says that it applies to out of network. And in the area that I sell in, there happens to be NO dentists in the network within 60 miles. So you need to check in advance beforehand and if no dentists in network be sure to warn the client. From what I can tell, it seems there are very few dentists who are in network for this CIP $20 cleaning benefit...

 

[policy doctor]

Yeah...thanks for the warning. They are waffling on handling this claim. Dr office should have called for authorization also before providing services. They did a panoramic XRAY and client said they told her that is the standard. Whoa...first I heard that remark.

 

[EltonHCP]

Medicare HMO dental benefits are terrible. It is not a benefit your client can rely upon to get anything done.

The dentists are also used to balance billing for every plan anyway so I would not hang my hat on the dental benefits.

It's great if you identify a dentist who is willing to accept the rates as payment in full. The problem is actually finding one.