It’s important to understand that your baby’s dental care starts with your healthy pregnancy. Baby teeth form before birth, and your diet and oral health are key factors. Your doctor’s advice on a balanced, nutritious diet and adequate vitamins and minerals is crucial. Don’t avoid your dentist; unfortunately, many pregnant women do. However, it’s safe to see a dentist during pregnancy, and it’s actually essential. Despite the increased risk of gum disease, pregnant women can maintain their oral health by visiting their dentist regularly, without any harm to their baby.

Food texture can cause problems with teeth. Sticky substances seem to find their way between teeth and along gum lines. The bacteria in your mouth interact with the sugars to weaken tooth enamel. Therefore, avoid candies such as toffee and anything gummy (such as gummy bears). If you do eat this type of treat, be extra diligent with your flossing and brushing afterward.

Wine may improve in flavor with age, but its high acidic content can harm your teeth. Wine’s acidity can swiftly erode the enamel of your teeth, leaving them vulnerable to damage. Additionally, the dark pigments in red wine and some white wines can cause stains on the teeth, affecting their appearance. Furthermore, indulging in wine can contribute to dry mouth, which can lead to oral health issues.

When you get a dental HMO and have to choose a dentist in the network, how do you choose the best one? I can only afford a dental HMO insurance plan. Since I do not have a current dentist, choosing one in a network is not a big deal other than ensuring stuff gets done.

Reply: You want to start with calling the dental office in the plan network of providers and confirming that they are still accepting the plan and new patients. Once you confirm that, the next step would be to ask some basic questions that may be important to you. Such as hours of operations, how long they have been in business if you have any special needs, and whether the office can address your needs. Do they have a website you can review for additional information about the dental office? You should check review sites such as Yahoo, google, and Yelp, to name a few. Remember that people tend to want to leave reviews when they have a terrible experience, but only sometimes when they do not. However, if one office has excessively bad reviews, you may want to rethink picking them as a provider.

Dental health care is critical, and there are many ways to ensure you do all you can for your oral health care. There are many ways to ensure you are doing all you can for oral health care: simple things like brushing your teeth at least twice a day, flossing daily, using tarter control, and gum care mouthwash. The primary dental care you do for yourself is low-cost and takes very little time each day. The next step is to see a dentist at least twice a year for check-ups and cleanings.

Cost can be a factor, but it does not have to be. One way to control dental costs is through a low-cost dental insurance plan. Many dental insurance plans offer free to low-cost preventive dental care. The money you spend on dental insurance is well worth it. And by seeing your dentist regularly, you will avoid any major dental issues. However, if you need more extensive dental services, having dental insurance will also help control your dental cost. Be thoughtful about your oral health and think ahead. Good dental care now makes for good dental care in the future.

Question: I just got some dental bonding on five teeth. However, I did not ask my dentist if it was okay for me to eat anything or if I needed to wait. If so, how long do I need to wait after having bonding done? I need to know.

Reply: You don’t have to wait to eat or drink after your appointment. However, you may experience slight tooth sensitivity to heat and cold after teeth bonding for a few days afterward. To prevent staining, avoid or keep to a minimum coffee, tea, soy sauce, colas, grape juice, blueberries, fresh cherries, and acidic foods like citrus juices and tomato sauce. You may want to call your dentist, who did the bonding, for any aftercare instructions, which they would typically give you at the time of your appointment.

What is Tooth Decay? Tooth decay is the destruction of a tooth’s outer surface from acid-forming bacteria produced by food containing carbohydrates (sugars and starches). Tooth Decay Prevention: Brush your teeth twice a day with fluoride toothpaste. Preferably, brush after each meal and before bedtime to help prevent bacteria from staying on your teeth for a certain length. Consider these helpful tips: Floss your teeth daily to prevent tooth decay and gum disease. Check with your dentist about using supplemental fluoride, which strengthens your teeth and helps prevent tooth decay. Consider dental sealants; sealants are placed on the top of the molars to protect the teeth from decay. Use mouthwashes with fluoride. Many kill 50% or more of the bacteria that cause tooth decay. Chewing gum with the ingredient Xylitol © may also kill some of the bacteria that cause tooth decay.

Question: I need to find a family dental plan where we can all go to the dentist whenever we need to and pay the dental office bills after the dental insurance company pays their part before making us pay our share of the cost.

In the past, we had plans to pay the dentist upfront for the total cost of our dental services and wait for the insurance company to refund us. In this day and age, who can afford to do that? I know we can not. 

Those types of dental insurance plans keep us from going to the dentist, and at that point, I do not see paying $120 a month for a dental insurance plan we do not even use because we can not pay upfront for dental services. What options are left for us that would be more affordable?

Reply: Welcome! I hope you are doing well today. I want to discuss dental insurance plans and how claims are processed. I can understand why the claims process can be upsetting, particularly regarding how claims are paid. Let me assure you that you are not alone. Many people have questions about dental insurance plans and how they work.

Based on what you have told me, you have either a dental PPO or an Indemnity dental insurance plan. If you like the plan benefits and coverages overall and it is just about how claims are paid, consider talking to your dentist. With dental PPO and Indemnity plans, the payment process and how the dentist gets paid is really up to the dental office. It does not typically come from your insurance company.

The dentist can choose to submit the claim and get paid by the insurance company before billing out any remaining balances to their patient. In the past, many dental offices processed claims that way. However, sadly, many patients would fail to pay their part, and then the dentist’s office would have to chase them down for payment. This is why many dental offices have started billing their patients in full and making them file claims to the insurance company to get paid back (refunded) the part due them.

Some dental offices charge you what they think your part of the cost would be based on your policy coverages, then bill or credit you depending on the outcome. However, few dentists still do this, as it can still be an issue of fully getting paid for services already rendered.

Based on what we have discussed, it is not an issue with the insurance plan per se but more of knowing how your dentist is willing to file claims and how they expect you to pay for services. Therefore, if you are still facing issues with your dental insurance plan, you may need to change your dental office, not your dental insurance plan. I hope this information was helpful to you. If you have any additional questions, please do not hesitate to ask.

Question: I have a PPO that has a waiting period for almost everything. Since I have the plan for seven months, I only have five more months until I can have significant services. When I bought the plan, I did not think waiting periods would be an issue and that I could wait them out. Now, I need a crown that will cost about $900.00. After the waiting period, the insurance company that I am with will cover 50% of the cost.

I need the crown now; are there better ideas than waiting five more months? My dentist said I should get the crown now since it will help protect my chipped tooth. Can I get the crown and file the claim after the waiting period? That way, I will at least get my $450.00 back in the five months after I file the claim. I hate spending money that my insurance company should pay out for.

Reply: I can understand your frustration with waiting for the insurance company to cover the cost of your crown. It’s good that you have consulted with your dentist and know the importance of getting the crown to protect your chipped tooth. 

Consider asking your dentist if they offer any payment plans or financing options. A payment plan could allow you to get the crown and pay for it over time rather than waiting for your insurance to kick in. 

I would advise against filing the claim after the waiting period. Most insurance companies have policies requiring claims to be filed within a specific time frame, typically within a few months of the service date. 

It’s important to understand that filing a claim for a service received during a waiting period but saying it was after could be considered insurance fraud. If someone files a claim with false information, the insurance company may deny it, revoke the policy, or even pursue legal action.

Suppose an individual receives crown treatment during the waiting period of their insurance policy and submits a claim stating that the treatment was accepted after the waiting period. In such cases, the insurance company considers this act as fraudulent. If the insurance company uncovers this false information, it will reject the claim and inquire into the policyholder’s other claims and medical history. This could result in a considerable hike in insurance premiums or even policy cancellation. Moreover, most dental offices file the claim to the insurance company, and it is doubtful that they would mistakenly mislead the insurance company about the date of service.

In short, honesty is always the best policy for filing insurance claims. It’s essential to follow the insurance company’s rules and regulations and not engage in fraudulent activities. If you have any doubts or questions about your insurance policy, it’s always a good idea to contact your insurance provider for clarification.

Ultimately, the decision is up to you. It may be worth weighing the pros and cons of waiting for insurance coverage versus paying for the crown out of pocket and considering any payment options that may be available to you.

Consider a Temporary Crown for Your Chipped Tooth: Benefits, Insurance Coverage, and Advice from Dentist

You could discuss with your dentist the possibility of getting a temporary crown until your waiting period is over. Temporary crowns are acrylic and designed to protect your chipped tooth, maintain your bite, and prevent further damage until the permanent crown is ready.

Temporary crowns are typically much less expensive than permanent crowns, which could make them a more affordable choice for you. Some dental insurance policies cover the cost of temporary crowns, even during the waiting period before placing a permanent crown. It’s always a good idea to check with your dental insurance company’s member service to verify if they cover temporary crowns. If they do, it can help you make an informed decision about your dental care and save you money. Feel free to ask your dentist about the pros and cons of temporary versus permanent crowns and which option might suit your situation.

However, it’s essential to remember that temporary crowns are less durable and long-lasting than permanent crowns and will eventually need to be replaced. Your dentist can advise you on whether a temporary crown is the best option for your situation and help you make an informed decision.  

Getting a Dental HMO Insurance Plan

An alternative solution to consider when needing a crown during a waiting period is to purchase a dental HMO insurance plan that does not have waiting periods. This option can help reduce the crown cost if you have yet to start any work on the tooth that needs the crown. 

However, it’s important to note that this may require you to change to a different dental office that accepts the HMO plan. Fortunately, many dental offices accept HMO plans, so finding a new provider that meets your needs should not be difficult. Be sure to consult with your dentist and insurance provider to discuss this option and determine whether it is the right choice.

Dental Discount Plan May Help You Save Money During a Waiting Period

Dental discount plans are an alternative option that can help you save money on dental services, including crowns, during a waiting period. These plans are not insurance policies but membership-based programs offering discounted rates for dental services. 

Dental discount plans typically have no waiting periods and can be used immediately. You can enroll in a dental discount plan and access discounted dental services, including crowns, immediately, even if your current dental insurance plan has a waiting period.

One of the benefits of dental discount plans is that they often offer significant discounts on dental services. The discounts can vary depending on the plan and the provider, but they can range from 10% to 60% off the regular cost of dental services. 

Another advantage of dental discount plans is that they are generally easy to use. Once you sign up for the plan, you can present your membership card at the dental office to receive the discounted rate. No claim forms or waiting periods; you can use the plan as often as needed.

It’s important to note that dental discount plans are not insurance policies, so they do not cover the entire cost of dental services. Instead, they offer discounted rates to help you save money on dental care. Dental discount plans may be a good option for people who do not have dental insurance or who have a waiting period on their current dental insurance plan.

Cash Discount May be an Option 

If you choose to get the dental crown during the waiting period, it’s worth discussing with your dentist whether they offer a cash discount for services not filed with insurance. Some dental offices may provide a discount for patients who pay in cash, saving them the time and cost of filing an insurance claim. It’s always a good idea to ask your dentist about any discounts or payment options.

Additionally, a cash discount could help you save money in the long run, especially if you don’t plan on using your insurance for any other dental procedures during the waiting period. However, it’s essential to remember that not all dental offices offer a cash discount, and the discount amount can vary. 

Therefore, it’s essential to discuss the cost of the crown with your dentist and any payment options available. Being transparent with your dentist about your financial situation can help them better understand your needs and find ways to work with you to provide the best possible care.

Finding Affordable Dental Insurance Plans with Dental4Less.com

In conclusion, waiting for insurance coverage for necessary dental procedures can be frustrating, but it’s essential to avoid committing insurance fraud. Filing a claim with false information can lead to severe consequences, including policy cancellation, legal action, and a considerable hike in insurance premiums. Therefore, it’s crucial to consider alternative options when needing immediate dental care, such as payment plans, temporary crowns, or purchasing a dental HMO plan without waiting periods.

Dental4Less.com offers a wide range of dental plan types that can assist you in finding an affordable and reliable dental insurance plan that meets your specific needs. Our team of experts is available during business hours of M-F 8-4, and we’re always happy to help. We understand that dental care can be expensive, and we aim to provide options that make it more affordable while ensuring you receive the care you need.

We believe honesty is always the best policy when filing insurance claims. Therefore, we encourage you to avoid fraudulent activities and follow your insurance company’s rules and regulations. If you have any questions or doubts about your policy, please don’t hesitate to contact your insurance provider for clarification.

In summary, exploring alternative options and finding a dental insurance plan that meets your needs is a better and more honest approach than filing a claim with false information. Dental4Less.com can help you find affordable and reliable dental insurance plans that fit your budget and dental care needs. Contact us today at 310-534-3444 during our business hours of M-F 8-4, and let us assist you in finding the right plan for you.

You should think ahead when getting dental insurance.

It may seem surprising that many people do not have dental insurance. However, dental insurance benefits are only sometimes offered through work, so people do without until a significant dental need arises. The problem with waiting until you need dental insurance is that it can be too late to get the type of dental insurance you want. You may need a dental PPO plan to stay with your dentist.

However, most dental PPO plans have long-term waiting periods, so you may not get the coverage you seek when not bought early. If you have a dentist you do not wish to change, find out what dental plans you would need to stay with their dental office. If you are with a dental office that only accepts PPO dental plans, you should consider getting a PPO plan now to have a plan in place for your future dental needs, whether for preventive dental care or major dental care.

I do not have current dental insurance and very little money. My dentist told me I needed dental work on my teeth, so I started looking for dental insurance. Right now, insurance seems too costly for me, but some friends tell me to avoid dental discount plans because they are not insurance. Is this true?

Reply: That is correct. Dental discount plans are not insurance. Dental discount plans help you save money on your dental care cost as long as you go to a dentist who is a provider of the plan. Discount plans are an excellent way to help make dental care more affordable at a low cost. If you want dental insurance, consider reviewing dental HMO plans. Dental HMO plans are the more affordable dental insurance option.

What Dental PPO and Indemnity plans have to offer. Dental PPOs and Indemnity plans allow you to choose your dentist, and for many people, that can be a deciding factor in buying those types of dental insurance plans. For people who want to stay with their current dentist or to be able to choose their dental provider, these types of insurance plans are for that. Dental PPO and Indemnity plans are usually more costly than HMO’s dental insurance plans. Are dental PPOs and Indemnity insurance plans worth the cost? The answer is yes. If you know your dental needs and understand the terms and conditions of the insurance plan, many people are happy with their PPO plans. Trouble comes when you fully understand dental insurance plan’s limitations.

I need to understand how dental insurance works. I have a dental insurance PPO plan through my job, but it could be better. I am considering removing it and getting just the medical. Why have insurance if you have to pay the dentist?

Reply: Medical insurance has a cost paid out by the insured, too. Dental insurance is designed to make dental care more affordable, not necessarily free. You may not think dental care without insurance is so bad, but to give you an example of how even in preventive care, dental insurance is worth the cost. Say all you need is preventative care.

Without insurance, preventive care costs (Office visits, Bite-wing X-rays, Oral Exam, and Basic Cleaning) can range around $200 – $400, keeping in mind most low-cost HMOs plan range from $8.00 to $20.00 a month with preventive care typical being free. More extensive dental care services become expensive when you don’t have dental insurance.

Are Individual PPO Dental Insurance Plans worth buying?

Some people may feel that getting dental insurance is not worth the plan’s cost. That may be true for some dental insurance plans if the person wanting it only wants the dental insurance for short-term use. Many people put off their dental care until they are in pain or have significant dental issues. Then get upset when they find out that many PPOs or Indemnity insurance plans have limitations that will not be able to help them with their major dental care needs immediately. A dental PPO plan is not for those who only want to buy a dental insurance plan to fix a current dental issue and then turn around and cancel the plan once they have their dental work done. The reason is that dental PPOs are designed to be long-term plans and not short-term ones. When considering buying a dental PPO or Indemnity plan, the thing to keep in mind is your long-term dental needs. When getting these types of insurance plans, it is a dental plan you want to keep for at least a few years.

PPO Full Coverage Dental insurance for a dental crown

Question:I require two dental crowns. I seek a dental insurance plan covering at least 50 percent or more on a crown and one without waiting periods. Is there a dental insurance plan like that?

Reply: We have two options for you; any of our HMO dental insurance would work. On the HMOs we provide, there are no waiting periods. The crown’s cost typically ranges from $100.00 – $250.00+. Another option would be our Delta Dental PPO plan. That does not have waiting periods; however, the first-year benefits on majors services such as crown run around 10 to 15 percent, and you only have 50 percent benefits on majors services once you have the plan for three years.

A safe and effective way to prevent cavities in kids is by having dental sealants.

Dental sealant is a plastic coating applied to the chewing surfaces of the back teeth, where decay mainly occurs. By going to a dentist, a dentist would be able to put on dental sealants to help protect your children’s teeth. However, even knowing this, only about one-third of children ages 6 – 19 have sealants. Cost can be a factor, which is why having dental insurance and or a plan in place will help many people and their families.

Before Choosing a PPO Dental Insurance Plan – Considerations
Similar to the HMO dentist, a dentist accepting PPO dental insurance members will do so to establish a patient base. Before choosing a PPO dental insurance plan, make sure that dentists in your area accept the plan. Typically, PPO dental insurance plans are said to offer better service and have fewer limitations than HMO dental insurance plans, but the premiums are usually more costly. The rates are generally lower if the insured member selects a primary dentist and dental specialist from the dental PPO network. However, the insured individual still has the freedom to choose a dental care provider outside of the established network.

PPO Dental Plans – Final Thoughts When Selecting a Plan

Participants insured with a dental PPO insurance plan are responsible for paying their deductible before receiving any reimbursement. One of the key differences between dental HMO insurance and dental PPO insurance is that DPPOs usually allow dentists to spend more time with insured patients. Dentists in dental HMO insurance plans are expected to see a certain number of patients, so some dentists have been known to rush through dental appointments. A PPO dental insurance plan consists of numerous dentists who sign up to join a network insurance system or group with the hopes that they will have many patients to service. When subscribers join a PPO dental plan, they benefit from lower out-of-pocket costs when they see one of the network dentists.

I am single with no kids and looking for a dental plan that is not only low on its monthly cost but also offers affordable coverage so I can afford my dental work. I live in California and only have a little time to read for days to find an affordable dental plan. I have to work ten hours six days a week to get by. I want to avoid sitting online looking through plan after plan. Can anyone tell me a few plans they know are cheap and can offer good coverage?  

Reply: You may want to review dental HMO insurance Options. One reason why a dental HMO can be an excellent low-cost option for dental insurance is that it typically has lower monthly premiums compared to other types of dental insurance plans. In addition to being affordable, dental HMOs also offer a wide range of covered services, including preventive care, restorative treatments, and oral surgery. This means you can receive the dental care you need without worrying about high out-of-pocket costs. Another advantage of dental HMOs is that they usually have no deductibles or annual maximums, which can further reduce dental expenses. However, it’s important to note that dental HMOs have restrictions on the dentists you can see, and you may need to choose a primary care dentist in the network.

I have a Delta Dental PPO insurance plan through work. I just used it for the first time yesterday. I got my regular check-up and cleaning. Lucky for me, that was all I needed to do. After having my dental cleaning, I was told I needed to pay the bill in total, which was $175.00.

I did not understand this because I told them my insurance plan with Delta Dental states they pay 100% for the services I just had. I told them I agreed that I had a $50.00 deductible, which I thought they would bill me for after my insurance company paid the claim.

I was told it was up to me to file a claim to get back my money from Delta Dental. I thought that was part of the dental office job. I am upset but glad I had the $175.00 to pay for my work. How do I file a claim with Delta Dental? I have never had to do that before, but I would like to get it to them ASAP to get my money back. Thanks for the help.

Reply:  The dental office should fill out the claim form for you as they know the ADA codes and services they provide. If they did not do that for you, ask them to do so. You are not wrong in understanding how dental offices bill you after the insurance company pays them, but only a few are willing to do that. Many more dentists want to get paid for their services and not wait for payment. Where you went wrong is that you should have asked the dental office staff about payment and how they handle filing claims before having any dental services rendered so that you don’t have ugly surprises you don’t want. 

To file a dental claim with Delta Dental, you can follow these simple steps:

1. Obtain a claim form from the Delta Dental website or your insurance provider.

2. Fill out the form completely and accurately. Remember to sign and date it.

3. Attach any necessary documentation to the claim form, such as receipts or invoices.

4. Mail the completed claim form and documentation to the address provided on the form or submit it online through the Delta Dental website.

Keeping a copy of the claim form and any documentation for your records is always a good idea. Once Delta Dental receives your claim, they will review it and process the payment according to your insurance plan.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

I want to get dental insurance that is low in cost and where I do not have to worry about filing my claims and waiting to get paid back. I am sick of paying my dental billing in full and waiting a month or more to get paid back. However, when I tried to look for plans like that, they were all dental discount plans.

Reply: My suggestion would be to review dental HMO insurance plans. A dental HMO (Health Maintenance Organization) is a dental insurance plan offering a network of dentists who provide dental care services to plan members for a fixed fee. With a dental HMO plan, you typically have to choose a primary dentist from their network and must receive dental care services from that dentist.

The benefits of a dental HMO plan include lower out-of-pocket costs for dental care services because the plan pays a fixed fee to the dentist for each service provided to you. This means you know how much you will pay for your dental care services in advance and don’t have to worry about filing claims or waiting for reimbursement. Dental HMO plans typically cover preventive care services like cleanings and exams at no cost to you. 

I want to get dental insurance, but I would also like the plan to offer vision insurance. I need a dental maintenance plan. I have good teeth, but I want to ensure they stay that way. I also need some vision insurance because I do wear glasses and contacts. My eye care is getting very expensive so that any help would be great. I want something that is budget-friendly.

Reply: We have both dental and vision insurance plans available. I suggest looking toward an HMO insurance option for a lower-cost option. If you are willing to choose an in-network provider of the plan, an HMO would be a budget-friendly option. If you have any questions about the dental insurance plan options we provide, please call our member services line at 310-534-3444.

I need a root canal. What would be the best dental insurance plan to get a root canal done at the lowest possible cost? My dentist told me that if I were to seek dental insurance to help me with the root canal cost, I would need to get a PPO. Would a PPO offer me the lowest price of a root canal treatment? I do not have $1600.00 for the root canal and a crown. 

Reply: Your dentist may advise a PPO primary because they do not accept HMO dental insurance plans. (you may want to call your dentist to confirm) If that is the case and you wish to stay with your current dentist, it is essential to read the plan terms and conditions carefully. Most PPO plans have *waiting periods that will affect the very dental care service you need. You will want to make sure you buy a dental PPO plan that does not have waiting periods. Also, ensure the *maximum limitation is high enough for your dental care needs. 

Consider reviewing a dental HMO insurance plan if you want to change to a different dental office. An HMO insurance plan has fewer benefit restrictions than a PPO, but you must choose a dentist in the plan network of providers.  

• Maximum Limitation:  A maximum limitation is the highest amount of money that a dental insurance plan will pay toward your dental care in a year. Suppose your dental insurance plan has a maximum limitation of $1,500, for example, and your dental care costs exceed that amount in a year. In that case, you will be responsible for paying the remaining balance out of your pocket. It is essential to review the maximum limitation of a dental insurance plan before purchasing it to ensure that it will cover your dental care needs adequately.
• Waiting Periods: Waiting periods are the amount of time that must pass before certain benefits of an insurance policy become available. In the context of dental insurance, waiting periods may apply to coverage filling, root canals, and crowns. When reviewing a dental PPO plan, make sure to know the waiting periods for basic and major dental care services. Typically, there are no waiting periods for preventive care. 

What is an excellent low-cost way of whitening your teeth? My teeth are not bad, but I would like them to be whiter. I do not have much extra money, so what is an excellent way to whiten your teeth without costing an arm and a leg?

Reply: There are a few low-cost options for teeth whitening that you should consider. One of the most popular options is whitening strips, which can be purchased at most drugstores. These strips are applied to the teeth and left on for a certain amount, usually around 30 minutes. They can be messy and uncomfortable, but they effectively whiten your teeth at home.

Another option is to use a whitening toothpaste. These toothpastes contain mild abrasives that help remove surface stains from your teeth. They are not as effective as other whitening methods but are a good option for maintaining a bright smile after using a more intensive whitening treatment.

Finally, consider making your whitening solution at home. This can be done by mixing baking soda and hydrogen peroxide into a paste. Apply the paste to your teeth and let it sit briefly before rinsing it off. This method can be effective, but avoiding damaging your enamel by using too much baking soda or leaving the solution on for too long is essential.

Who do I call when a dentist lies to me about my dental insurance paying a claim? I had to do a root canal, and my dentist at the time told me that my insurance plan would pay 50% of the cost of the root canal. He said the total cost was $800.00, but my cost would have only been $400.00. $400.00 is a lot of money, but I got that together to have the root canal he said I needed.

Yet when I got this bill in the mail, I was being charged $640.00 for the root canal instead of $400.00. I thought it was an error and called the dental office. They said my insurance plan did not cover as much as they thought, so I owe them $640.00. I called my dental insurance plan, and they told me that since I went to an endodontic, they cover 50% of the cost of the UCR, up to a general dentist’s cost. 

I called the dental office, who told me that the dentist in their office who did my root canal was a specialist, so that is why the claim got filed that way. I told him I would only pay the $400.00 stated to me when I was having the root canal done.

I am so upset I only did the root canal because of the price they told me I had to pay. I was bate and switched. I am still getting the billing for the difference and do not feel I should have to pay it, but they are stating they will put it on my credit report. Who do I call about this?

Reply:  In most cases, when a dental office provides a price based on your dental insurance plan benefits, they will inform you that it is still an estimate and will depend on what your insurance company pays. Most dental offices will charge you in full for dental services, or you may at least pay a portion of what they think your plan will not cover. When they do this, they will say any adjustment up or down will be billed or refunded to you, whichever the case is. 

Most PPO plans base coverage paid out by percentage—for example, 50 percent of the cost of major services. But that is only part of it. Coverage is also typically based on * UCR fees. These fees can occur when choosing an out-of-network provider, a dentist not in your rated area, and when going to a specialist. In your case, it was going to a specialist. Typically, the specialist cost for services will be higher than a general/family dentist, pushing you over the company UCR cost. All of this will be in the terms and conditions of your dental insurance policy. 

Your dental office gave an estimate of cost based on the basic coverages your plan provides, which is not a case of a lying dental office. Understandably, you are upset due to the unexpected costs of having your dental care. Whether this is a miscommunication with the dental staff providing the cost is unclear. It seems as if you were not fully aware of your dental insurance plan benefits and did not ask all the questions needed to understand the cost of having the services rendered. Regarding who you can call about the additional cost, I have no advice to provide you after the fact.   

I do have a suggestion moving forward. Most insurance companies will do a * predetermination of dental benefits. Many encourage you to submit a predetermination of dental benefits for any service over $300.00 to help avoid this issue you are currently having.  

• Usual, Customary, and Reasonable

• A predetermination of benefits is a written estimate from your dental insurer of the amount your dental plan will pay for a specific treatment based on information provided by your dentist. 

I am having difficulty finding a dental insurance plan that will cover adult braces. I am 26 and need braces to help straighten my front teeth. I can not pay for it all out of my pocket, so I have been searching for dental insurance to help cover the cost of braces; so far, I am still looking for a solution. Every plan I have come across either does not offer braces or does not offer braces to adults. What is out there that can help me with the cost of adult braces?

Reply: There are dental insurance plans that offer adult braces, though you may have better luck with an HMO. HMOs are less restrictive about benefits. However, you do need to choose a dentist within the plan network of providers. Another saving option for adult braces would be a dental discount plan. Like an HMO you need to select a dentist that accepts the plan. Yet most dental discount plans will offer discount savings on any type of braces.