Why We Pay More Than We Have To For Dental Work

Nobody likes going to the dentist, right?

The way I figure, though, is that it’s a necessary part of life (if you want teeth past your 50’s), so you might as well make the most of it.

I’ve always paid more for dental work than is absolutely necessary, and I’ve never regretted it.

We have a dentist that doesn’t participate as members in any dental plan.

Dentist by Gamma Man, on Flickr

What does this mean?  That while insurance plans will cover their work, they do not have negotiated rates with any one insurance company.

And I wouldn’t have it any other way.

The way my insurance is structured, a basic cleaning is still covered, but instead of covering 100% of a negotiated rate with an in-network provider, they instead cover 90% of the negotiated rate cost, with the rest being my responsibility.

So, I’ve found that the basic cleaning is covered at $65 by my insurance plan.  This means if I went to an in-network provider, they would pay that provider $65 and I would pay nothing.

My dentist charges roughly $75 for the same cleaning.  The insurance company pays them 90%, but only 90% of the $65 that they normally cover, meaning they pay $58.50.  Since my dentist isn’t participating, they expect the full $75, meaning I pay $16.50.

But why would I pay $16.50 when I could pay nothing?

Because I know the office.  I’ve been going to the same office for about thirty years.  I had the same dentist for roughly 25 years, and I’ve had the same hygienist for almost ten years now.  When it’s time for my appointment, they don’t have to tell me what room I should go to, because I go to the same one.

I know the care they provide.  Even though there’s new dentists, the original dentist still has majority ownership of the practice, and institutes standard practices of care that the other dentists must abide by, and they’re high standards.

Plus, I’ve heard too many horror stories otherwise.

Before we were married, my wife used her insurance, found the office closest to her and went.  Each time she went, she got a different dentist.  She got one filling done that never felt right and later had to be completely re-done (by my dentist).  She had to constantly wait.

After awhile, she even went to a different practice.  Same results.

I’ve heard others started postponing or even skipping appointments because they hated the experience at these ‘sweat shops’.

Outside of the cleaning, there are the x-rays and other work that they do.  The average out-of-pocket is $25-30 for each visit.  For the two of us, that’s meant that we pay about $115 a year, which will increase as the kids start getting dental care.

Still, that’s a small price to pay for having confidence that our dentists and their office staff are trustworthy and will provide good care and accurate diagnosis.

Will this practice be around for another thirty years?  Maybe, maybe not.  But, for as long as I live here, this practice is open, and they still provide dependable care, they’ll get our business.  Even if it costs a little more.

Do you pay more for dental or medical care than you otherwise have to?

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17 thoughts on “Why We Pay More Than We Have To For Dental Work

  1. Insurance usually covers my dental, so I don’t pay at all – if I do have to pay, I just don’t go. I know that’s a horrible way to think, but I’ve had insurance all my life so I’ve never had to cross that road.

    If it were just a cleaning, then I’d just pay the cheapest, but for actual dental work, my teeth are too important to me to go cheap!

  2. I have a very good dentist who is in network (PPO). I am even more particular about my doctor. He is part of the Blue Cross PPO network. My doctors are doctor’s doctors. These are the guys the doctors go to. I pay my deductible and 20%. It is worth it to me to have the best doctors..

    • I agree. Luckily our insurance plan has covered all the doctors we’ve chosen along the way for ourselves and our kids.

  3. You are absolutely right about how you are handling your finances regarding your dentist visits – it really makes all the difference in the world to get the best care and treatment when you see your dental professional, and with your loyalty to your dentist you KNOW what you are getting. In the Orthodontics profession there’s the added element of extremely busy families trying to fit in their office visits (and there are quite a few during the normal course of having braces – time is money, too 🙂 and so we initiated a new procedure where there’s a no-cost first visit with all xrays and dental molds done in an hour and they’ll be ready to get fitted with their braces next visit.

    • Good stuff. Haven’t crossed the ‘orthodontics’ bridge yet but likely is in the cards for when the kids get older!

  4. I really never stopped to think about it. Although I never pay to go to the dentist, but if it did start receiving bills I would question it. I go twice a year for the cleanings and generally get a clean bill of health. I think my wife and I figured it out that we are essentially paying for the cleanings through the premiums. The dental premium is so cheap that it equates to the cost of 4 cleanings between the 2 of us.

    • True. Premiums basically equate to the out-of-pocket costs, but the peace of mind of having coverage when you have other things come up is worth it to me.

      • It is definitely worth it to me too. Thats how we all sleep at night is the peace of mind with all the various insurances that we have. If you stop to think about it we have alot of insurances.

  5. I never gave this much thought until I met the bf. He has very soft teeth and has had a lot of dental work as a result. He’s also very nervous to go to the dentist, so for us it’s worth it to pay for the out of network co-pay to make sure that he’s comfortable with his dentist (and to make sure they’re not trying to “upsell” us for procedures that don’t really make a difference).

  6. Our dentist is out of network (my husband’s dental plan keeps switching), but worth it. Our dentist has put my husband at ease and the work is always superb.

  7. Ooh, this is a touchy subject these days for me! My dentist has told me the last two times that I need braces (or invisalign.) My teeth have always been straight and I never needed braces before, even as a teen, so my husband thinks he’s full of it and just trying to get money out of us. I would like a second opinion as I don’t really like this guy or trust him fully either, but our insurance will only pay twice per year….and I just went. I guess we will look again in a few months and see if the next dentist thinks I need braces. To answer your question :), we have a dental plan that’s pretty terrible. If something is “covered,” that means insurance will pay 60%. That’s not covered…that’s discounted. And they don’t cover braces or invisalign past the age of 19. (I’m just a few years older..;) Pretty annoying…

    • I think ours would allow for braces at any age, but they have a lifetime max that I’m sure is well below the full cost.

  8. You say this now because your coverage still covers 90%. If it covered nothing and your choice was between this one and one that was fully covered I don’t think you’d make the same decision.

    • I agree with this. It’s not far fetched to say that most people are going to behave differently without insurance coverage, whether it be dental, medical, auto, etc. I was simply discussing the circumstances and choices that tie back to the coverage that I do have.

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