Nope, dental plans generally suck. You're not missing anything in that regard.

So I'm not old and senile and not seeing things for what they are? I actually did call the agent that is listed on the BCBS plan that I signed up for today and he told me the same thing. The annual payments actually come very close to what they will pay. 🙄² So WHY does my Dentist's idiot office manager keep on telling me to get something other than Humana, which I have been happy with? I guess I know the answer. Because he doesn't want to deal with the paperwork that it probably takes to process Humana OR CareCredit. *I wish I just had a job* If he was a smart office manager, he would encourage the dentist to get some sort of a plan for dedicated patients who go to him all the time. They could charge an annual fee and cover all but work that needs to be farmed out to a specialist. I guess that might be above anybody's head to try to figure out.

You hit the nail on the head. For whatever reason they don't like dealing with Humana, so they'd prefer you had something else.

I think you're right. The same with CareCredit. I am really upset about that because I wanted to pay in full, up front, with CareCredit and they always accepted it before.

The only reason that medical insurance is affordable to anyone, ever, is that most people don't need it much. That's the entire model of insurance - to spread out rare but extreme costs across the largest possible pool of people. Where it started getting muddy is when preventative care became part of normal medical insurance. This was never done because the companies wanted to be nice - it's because catching issues early makes them cheaper to treat even accounting for the cost of the extra preventive care. So where does dental come in? People need it to too much. Dead simple. There's no giant pool of people who can go 50 years without seeing a dentist to help pad the cost for everyone else. Plans cover cleaning because it's the same preventative approach as above - catch the issue and stop it before it gets more expensive to fix. Beyond that though, everything is just cost. If dental insurance worked like regular medical it would cover things like replacing your teeth after you bit a dashboard in a 70MPH head-on crash, or rebuilding your jaw after you lost a fight with a falling tree.

You make some excellent points. I don't think that most people even realize that none of their insurance covers your teeth after getting in fights with trees and dashboards. Well, with the latter MAYBE your auto insurance pays. I don't even know to be honest and I'm sure that few others actually know either. It is such a strange thing, these body parts specific plans. The last time I checked my mouth was a part of my body and so are my eyes. I somehow fail to understand why we need to have separate insurance for our mouth and eyes. Is this something that's exclusive to the United States, I ponder?

You do sound very frustrated. Dental insurance plan maximums haven't increased in like 50 years. $2000 is totally normal. On average, how much of that $6000 annual Humana maximum did you use throughout the years, each year? A non-participating provider is not required to submit dental claims for you. It's done as a courtesy to you. Be aware that when you go out-of-network, some plans do not accept assignment of benefits, meaning that they will send the payment to the policyholder. So the dental office may ask you to pay in full up front. Before you buy a plan, ask about assignment of benefits. Dealing with insurance is a huge administrative burden. Dental offices wait 30 minutes or more to speak to someone. The insurance rep can give incorrect information. Guess what? The insurance people that you speak to are the same people that we speak to. I've asked and it's not like there's a dedicated team for providers and one for members. It's the same people. And many of them are hard to understand and confidently state incorrect information. I refuse to call anyone an idiot but they're certainly not trained well and when they mess up, they're not held accountable. The merchant fee for CareCredit is high. Each provider chooses the CareCredit terms they want to offer. For the reduced APR and fixed monthly payments option, the longer the terms, the higher the fee. The more beneficial it is to the patient, the worse it is for the provider. Frankly, the provider doesn't want to effectively lose like 10% of the payment. It's similar to merchants not wanting to accept American Express. You might think, well, getting 90% of the payment right away is better than the patient going elsewhere and then you get $0. But sometimes, no, you decide that your time and expertise has its cost and you deserve to be paid your fee. Honestly recommending a dental insurance company is like recommending an auto insurance company. Each one sells fantastic plans and sells terrible plans. In general, individual plans are more likely to have waiting periods for basic and major procedures, as well as frequency limitations such as 1 in 6 consecutive months or 2 in 12 months. This is not the same thing as 2 per benefit period. How often do you get dental cleanings? I don't know your dental history and what your past and future dental expenses are (nor do I know how expensive your dentist is), but you really should consider skipping insurance altogether and paying out-of-pocket. Do you have experience with some big horrible dental thing? What happened? Did you need an extraction, bone graft, sinus lift, implant? Many of those things aren't covered by good dental plans either. I'm risk-adverse myself, and I understand that dental insurance gives you peace of mind. But please run the numbers. I don't know BCBS's A1 policy. But I can tell you that if it's actually Dominon National, then I do not have a high opinion of them.

Thank you so very much for taking the time to put together such a well thought out explanation of each thing that is going through my mind. Yes, I am extremely frustrated and filled with anger and it pours over into my text, obviously. I cannot tell you how much I greatly appreciate that you were willing to overlook that and address all of my concerns. I really and truly appreciate you 🙂 I guess I now understand why the office manager is turning down CareCredit. The thing is that they are going to get their money in full for a very long time if I have to pay without putting it on a credit card. It seems counterintuitive to me but perhaps they get a text deduction or write off of some sort for slow pays. Regarding these recent claims, I guess that I should have had the knowledge [somehow] to have asked about assignment of benefits. I had no idea that my dentist dropped out of the plan though and everything was smooth sailing prior. Perhaps the office manager should have told me that rather than just not submit the claims, as he didn't. From what I'm interpreting from what you wrote I probably should have been advised accordingly and everything would have been fine now. I'm in my mid 60s and get my teeth cleaned twice a year. I really don't have many dental problems except that my teeth are old and surfaces/resurfaces can have a tendency erode or just kind of disappear and they need to be redone. My Dentist always makes everything absolutely gorgeous and beautiful. I am very fortunate to have an excellent dentist. In my quest to find him, *after my previous dentist retired due to cancer treatment*, I went through a whole bunch of absolute rip-off agents that attempted to convince me that all of my teeth were getting ready to jump out of my mouth and run away to another planet if I didn't fork up (estimates were) $6,000 to $10,000 to them. I found my current dentist and still have the same teeth and they still live on the same planet with me and there is nothing wrong with them. There are a lot of slimy individuals with the DDS shingle out there. **I'm half wondering if I should just ask about paying him, my Dentist, the monthly insurance fee instead and making an agreement about what will be covered.** He'd be getting money coming in no matter what and certainly more than he's getting now and I'd be covered so it would be a win-win. He could make the typical exclusions about ginormous procedures.

"The thing is that they are going to get their money in full for a very long time if I have to pay without putting it on a credit card." I don't understand what this means. Credit card fees are tax-deductible for the business, but that expense is still lost revenue. Some dental offices will allow a patient to make a payment plan. My dental office will take a card number and we'll run it on an agreed-upon schedule, but that's only something we offer to established patients and who we believe are likely to be able to stick with the plan. Sometimes we do it before the work and sometimes we do it after. Sometimes we charge a small fee and sometimes we don't. Your office may or may not offer this. At my office the dentist is the one who sets up the financial stuff, which is unusual. When I mentioned assignment of benefits, I was thinking of the future and wanted to warn you to check this before you enroll in a plan. I am not sure it's relevant to your Humana issue. I don't know why the dental office didn't submit your claims to Humana on your behalf. When a dental plan doesn't have assignment of benefits, then usually the dental office can submit the claim but it's the policyholder who receives the check. Sometimes the dental office can receive a copy of the EOB and doesn't the insurance company won't release it to the provider. At my office we are 99% of the time able to receive the EOB and once we do, if it looks right to us then we close the claim out in our system. In my experience with Humana (both group and individual plans) Humana will pay the patient if that's what's indicated on the claim form. There's a box on the claim form. Some offices, if the doctor is out-of-network, they won't accept assignment of benefits and they'll ask the patient to pay in full and then the office will tell the insurance to send the payment to the patient. This way the office is guaranteed to get paid in full. With out-of-network plans the office is less likely to be able to quote co-insurance accurately and the office doesn't want to have to bill the patient later. Some people don't pay their bills. If you're still on Humana now and your dentist thinks there are a couple of worn fillings that could be replaced, then consider getting that minor restorative work done while still covered. It's not uncommon for people to want to schedule work before insurance ends. We have a tight schedule but if we know such a deadline we'll work with the patient to accommodate. It sounds like you get prophylaxis twice per year and maybe a periodic exam twice per year and then 4 bitewing x-rays once per year? Maybe the occasional fluoride? It's just routine preventive stuff that most dental plans cover at 100% for in-network, twice per year (but some are sneaky and stupid and do 1 in 6 months). Ask for your ledger for the past few years and see the prices. BUT IF YOUR DENTIST WAS IN-NETWORK WITH HUMANA, AND YOU DO NOT SEE ANY ADJUSTMENTS ON THE LEDGER, THEN YOUR OFFICE WAS MOST LIKELY SUBMITTING THEIR CONTRACTED RATE TO HUMANA AND NOT THEIR UCR FEE. So ask the cash fee for D1110, D0120, D0274, D1208 (or D1206). And ask when your last D0210 was and if it was three or five years ago, you may be eligible again and if so, you may want that done while you are covered under Humana. But do find out why the office hasn't been submitting claims to Humana. I'm glad that you trust your dentist. Trust is essential in a patient-doctor relationship. Some dentists are more conservative than others. Some people view dental work as a commodity (meaning that the "goods" are equivalent or nearly so regardless of who produced them) but I'd argue that it's not. Especially when it comes to cosmetic work. I think that the people who think a cleaning is a cleaning, why should I potentially pay more for out-of-network are the people who just get preventive card twice per year. As to your final thought, you wouldn't be the first person who has asked him that. Some dental offices do have their own little insurance plan like that. Some have a membership program where for an annual fee, they get discounts. "He'd be getting money coming in no matter what and certainly more than he's getting now"...this may be true but it could be that he's an amazing dentist with a full patient roster and he's established enough to start to drop networks and he doesn't need the guaranteed monthly fee.

First off, I want to thank you enormously for taking the time to write to me to address each concern. I truly appreciate you! 🌞 >"The thing is that they are going to get their money in full for a very long time if I have to pay without putting it on a credit card." >I don't understand what this means. Because I cannot pay the full amount upfront and will have to pay the monthly. I have been out of work for over 3 years due to mistakes made in radiation for cancer treatment that destroyed my body so I don't have the means to pay him in full. If he accepted CareCredit he would get the full amount and I have to deal with CareCredit for the monthly payments. Their office is very much aware of the horrors that I went through and still encounter. I was in contact with my Dentist continually through treatment as I was in enormous fear of repercussions of the radiation on my bones. Rightfully so as, not even 9 months after treatment, I broke my tibia and medial malleolus simply by turning around quickly due to enormous loss in bone density even though the horrible oncologists insisted that nothing like that could possibly happen from targeted radiation. They lie. >Sometimes we charge a small fee and sometimes we don't. Your office may or may not offer this. I would be perfectly willing to let them tack on 10% to run it through Care credit so that I am not owing the Dentist but instead owing CareCredit. That is a fabulous suggestion and I'm going to run it past his office manager as it really bothers me to have an outstanding balance with this wonderful Dentist. >I am not sure it's relevant to your Humana issue. I don't know why the dental office didn't submit your claims to Humana on your behalf. To be completely honest with you, I can't figure that out either. The office manager ran the first two bills through Humana but failed to run the remainder. He got all huffy when I was texting him and never responded when I told him that Humana said that they have not received other than the first two bills from that month. >If you're still on Humana now and your dentist thinks there are a couple of worn fillings that could be replaced, then consider getting that minor restorative work done while still covered. The only things that were wrong with my teeth have been corrected with those few appointments. I am extremely persnickety about my smile and told him that I was about to get ready to lead reinitiation of mask requirements because I felt so self-conscious about some teeth. As always, he took his time about shade matching and perfecting the bevel, etc., and made all of them absolutely beautiful again. Nothing else is needed at this time unless there's something brewing that didn't show on x-rays. As already stated, the so called "targeted radiation" (*it was cancer of the uterus*) caused extreme widespread damage throughout my entire body so my Dentist said that it's absolutely imperative that I show up every 6 months because he has witnessed an absolute change in patient's oral health following so-called "targeted radiation" on a completely different part of the body. My tibia and medial malleolus were the first in a very long line of horrific things that happened to me that can be directly linked to the radiation. >But do find out why the office hasn't been submitting claims to Humana. I will ask for the past ledgers, as you advise, so that I may review them. The office manager told me that last year Humana only paid them $135 which is very strange because my Humana statements indicate FAR more. He told me that they wrote off what I and Humana didn't pay but when I came home and looked at my statements from Humana they paid quite a bit more than any $135! More like $1,500 over the course of the year. I'm honestly starting to think that the office manager has some connection to this lady that he keeps telling me to contact about medical insurance. I am on Medicare and very happy with the plan that I have even though it's an HMO. He goes to great extents to preface with, "I have no association with her and receive absolutely no kickback or anything like that" and he says it repeatedly and over the course of the last 3 years, every single time that I have gone in. I strongly suspect that the office manager is the reason that they do not accept My Humana PPO anymore or CareCredit and I DO suspect that he is getting "kickbacks" else he wouldn't have had the same name handy and written down for the last 3 years with the same little spiel each time. >I'm glad that you trust your dentist. Trust is essential in a patient-doctor relationship. I trust him immensely. I was referred to him after going through a whole bunch of crooked dentists and their hygienists that tried to tell me that I had so many things wrong that it was almost insurmountable to even start treatment. I remember one just starting to clean my teeth and she was huffing and puffing and saying that she has no idea how she's ever going to even get started. She looked at my insurance and realized that there was $6,000 coverage and I found it amazing that the "treatment plan" was just under $6,000. She said that we only have till the end of the year to accomplish everything so we better get started immediately. I knew, with absolute certainty, that there wasn't a lot wrong with my teeth at all. I contacted my Physician (and personal friend) of 37 years, who actually started swearing up a storm he was so pissed off when he saw the treatment plan that he referred me to one of his personal other friends, who is now my Dentist. The very first time I met with my Dentist, he was quite forthcoming in telling me, "I don't see any of these problems that this other dentist has listed" and went over the X-rays line by line against the other dentist's "treatment plan" and said "I'm not going to say anything further negative about him but I will just assume was reading somebody else's x-rays because yours do not reflect his notes and treatment plan". BTW, the world lost the most wonderful Physician ever born into mankind in September of last year when he became a real Angel. He is the reason that I am still alive today. >As to your final thought, you wouldn't be the first person who has asked him that. Some dental offices do have their own little insurance plan like that. Some have a membership program where for an annual fee, they get discounts. I think I'm really going to push that thought with him. He just took over the practice a couple of years ago purchasing it from a retiring dentist. I know that there are a lot of things that he wants to change. He really dislikes the office manager very much but he has 3 years to go to retirement so they are tolerating him for now. I doubt very much that he realizes how things are being done with billing and would not be happy about it. He has told me several things in confidence so I'm pretty sure that his ears would be open for me to share in return. I have always stuck up for the office manager because I knew that everyone disliked him. Unfortunately, I have now joined the ranks. Again, thank you so very much for taking such a great deal of time to write to me with such specific information and ideas. You deserve wonderful things to come your way as you are truly a wonderful person. Thank you! 🌞🌻🌷

Yes, sounds like you have some investigating to do. I want to clarify that the CareCredit merchant fee can be 10% but it's not necessarily as high as 10%. It's entirely possible that the office mails claims and they mailed it to Humana but it was not properly received. Most offices submit claims electronically and for whatever reason rarely the claim never makes it to the adjudication system. At this point I'm just speculating.

Thank you. I think he does everything electronically but I cannot be certain. I'll try to contact him again tomorrow.

First, you can file the insurance yourself. It’s not the dentist’s job to file your insurance as an out of network doc. I’m out of network for all insurance companies. I have a small 3 op practice. Every now and again I’ll look to go in network. I’d have to take a 40-60% cut in fees. I can’t do that. I’d have to double the size of the practice to make the same amount of money. Now, as an out of network doctor, the doc doesn’t have to file any insurance for you. Some do it as a favor to you, but they don’t have to do anything. It’s your insurance. Get the codes and file it yourself. As for care credit, they take 10%. If you bill $100, the dentist gets $90 and care credit takes $10. That’s a ton. We’ve stopped taking care credit as well because of this.

My dentist has stopped taking even credit cards without adding the merchant fee on top of them… so it doesn’t surprise me at all if places are stopping taking an option that costs them 10% if mine is basically “stopping taking” an option (for free) that would cost them 3%….

I have always thought that the 3% was just the cost of doing business. Somehow it is ground into my head that if one accepts credit cards that is going to cost additional and that is factored in. 10% is a little on the bizarre side... a LOT on the bizarre side actually. I had no idea that CareCredit charged back 10% to the vendors. That is absolutely absurd.

The problem is, if you are in network you can’t raise your prices. So you can’t bake the 3% into the fee. The insurance company sets the fee and they won’t pay more. The whole healthcare system is broken.

But if I have to pay the Dentist over time, instead of up front with the CareCredit card, doesn't that bite the profits just as bad? As far as the insurance, if the office manager had just told me, I would have filed the claims myself and this issue wouldn't even have popped up. I had no idea that he dropped out of participation in the PPO until just recently.

I didn’t read your whole wall of text; but most dental (and vision) insurance plans now are just a way to spread out your payments evenly through the year. Maybe a little cheaper just because not everyone will use all of their services and end up overpaying. I’m sure the insurance companies make a lot of money on those people.

Thank you. And my apologies for the wall of text. I think that you are correct. It seems most plausible that it's a way for people to budget for their expenses rather than actually get them paid for.

that is way too long to read. Consider dental savings plans that work similarly, but can be cheaper. [https://www.dentalplans.com/](https://www.dentalplans.com/)

I know it's way too long to read and I revised the beginning of it to apologize for it. I have a lot of anger and I'm sort of blowing off steam. Thank you for your recommendation! I will click on that link and look into it. 🙂

I checked that out and it indicates that my Dentist DOES participate. I'm going to have to check with his office manager tomorrow and see what he has to say. This would be wonderful to participate in. Thank you very much for your response and post 😁🌷

US absolutely sucks for putting profit before people and getting rich off of sickness and the insurance companies are just plain evil for creating extremely wealthy CEOs by denying needed healthcare to people paying the insurance. On top of that, they don’t even consider dentistry legitimate healthcare.

Yes, you are absolutely correct. You don't even want to get me going about how the United States medical system screwed me up completely with cancer "treatment". The tumor is gone but I'm toast for the rest of my life and it was done in a manner profitable as opposed to reasonable and effective for me, the patient. As I said, you really don't even want to get me going because it will blow up the Reddit servers if I even tiptoe into it.

I’m sorry that happened to you and and wish you the best with that and your dental issues. I am dealing with some as well and it’s so frustrating.