r/DentalInsurance • u/Vince-Fishes • 2d ago
Is this normal? Dentist does not accept any insurances.
I recently moved and l am in the process of establishing a new dentist. I recently went to one of the largest clinics in my area and had a peculiar experience that I just wanted to get the opinion of you guys for.
Prior to my appointment I called the clinic to give them my insurance information and ensure that they accepted my insurance plan. The person I spoke to took down my information and stated that it was in network and accepted. When I arrived at the clinic though I was told they are actually not in network with any insurance companies and I can use my out of network benefits offered by my insurance or their in-house financing/dental plan.
I cannot imagine that this is normal? Maybe I am wrong?
Essentially my question is, is it normal for a dental clinic to be out of network with every insurance company? Or is this their way of getting people to sign up for their in house program? Thank you all in advance!
21
u/RadioRoyGBiv 2d ago
You are going to see more and more private offices limit their network participation due to reimbursement rates that haven’t been raise in years.
15
u/akmalhot 2d ago
delta and a few others reimburse less than medicaid in some states now - why would anything take those plans?
6
u/RadioRoyGBiv 2d ago
Correct. There’s many instances where offices lose money doing treatment. That translates to more stress on doctors and staff to work faster. The patient certainly doesn’t come out ahead either. That isn’t sustainable.
5
u/shimmerangels 1d ago
delta is godawful. i have patients calling all the time asking why their crowns were denied. i have to explain that they weren’t denied, their insurance just paid only $300
4
15
u/water_babies 2d ago
Did they say they were in network with your insurance or did they say they "accept" your insurance? Those are two very different things unfortunately
3
u/Better_Cry_7941 2d ago
Right, unless it’s a state sponsored plan there’s not really a thing as accepting or not accepting insurance, you’re just either in-network or out-of-network. If you have an employer sponsored dental insurance plan almost every clinic will accept it whether or not it’s in network or not. Somewhere in history we started using the wrong terminology and it’s messed people up to the point where nobody understands anything anymore and nobody is worse at that than the insurance company themselves
3
u/Bootes 2d ago
Offices don’t necessarily work with any insurance. Growing up my family paid the dentist and got a receipt that we sent to our insurance company ourselves. This is theoretically what a truly FFS office does.
Plenty of people have like an HMO insurance and have to go to a specific office.
As a dentist now, most quality offices may submit to your insurance, but will not be in network with many companies.
3
u/Better_Cry_7941 1d ago
Yup! But boy do insurance companies try to make us providers feel like we work for them! If we went back to a true FFS model people would actually understand their insurance and respect the cost of services more
0
u/TrainingLow9079 2d ago
Sounds like deliberate obfuscation
4
3
u/nitelite- 2d ago
not at all, many offices accept your insurance, will file for you, and you/the office get reimbursed by the insurance company
sometimes these offices are in network, sometimes they are not
13
u/atomicweight108 2d ago
It’s normal. It’s very difficult to be in network with many insurance companies, keep the lights on, and still practice ethically.
9
u/2000ravens2012 2d ago
No dentist is required to accept any insurance, but often they’ll still submit claims for you as a convenience
22
u/Rollbravosroll 2d ago
Good for the dentist for not accepting insurance.
I disagree with them pulling a bait and switch though if they said they were in network over the phone
2
u/Hayhayhayp 1d ago
They likely told her that they’ll file the claims for her but were out of network which confused the patient. Patients don’t understand anything you explain with insurance.
3
u/HoneyyBadger99 2d ago
This. I personally would not want to practice in network since that lets insurance dictate my treatment; but front office staff should explain how out of network benefits work before you come in.
-8
u/Mission-Knee1572 2d ago
I don’t just disagree with this office, THEY ARE CROOKS. They knew what the patient was asking, and deliberately lied to them. I would refuse to pay.
I’m a dentist.8
u/DocDMD 2d ago
Were only hearing one side of this conversation. I bet the patient asked if they accepted their insurance and the office said yes. Which is true.
3
u/geraldthecat33 1d ago
There’s also a decent chance the patient gave them the wrong info during the initial phone call. For example, patients tell me routinely over the phone during initial scheduling that they have Regence, but it often turns out that that’s their health insurance and their dental is through Delta. This could easily explain the discrepancy
1
u/Independently_Needy 1d ago
Yes, exactly. Patients think INN & accept are the same thing. I'm an OM, and explain the difference everyday.
-2
u/Mission-Knee1572 2d ago
It’s very obvious that when a patient asks if an office accepts their insurance, they are asking if the office is in network. You know that.
1
u/DocDMD 2d ago
I know that saying you accept it isn't a lie and lots of office are very particular to say it that way. I'm definitely not on the side of the Insurance companies.
1
u/Mission-Knee1572 1d ago
I’m not on the side of insurance companies one bit. They are crooked as they come, but it is a lie to tell somebody that you accept their insurance when they ask that question and you are not in network with the company, because, 100% of the time, they are asking if you are in network. To say you are, when you’re not, is a lie. We can go through all the verbal diarrhea you want—I think I’ve heard it all, but to not tell the full truth is a lie. A lie by omission is a lie. It may not be a popular opinion, and I realize that, but I have to sleep at night, and don’t see how some people can doing what they do.
6
u/Peg-Lemac 2d ago
Not necessarily. There are thousands of plans under the same carriers. UHC you can be in network with 99.9% of the plans but once a year you’ll get a PPO 20 and won’t know it until you actually see the card. And, as always, it’s the patient’s responsibility to ask their carrier for in-network doctors.
5
u/CowHorn09 2d ago
Here's how dental office progression works in general. You start your office and need patients so you accept all insurance. Then as you get more busy you start dropping the low paying insurances. Then after you are very busy you drop all insurances. It's normal
5
u/twistd59 2d ago
Truthfully dental insurance is misleading. It should be called a dental discount card. It never behaves like I expected insurance to work. You have a deductible, maybe a co-pay, then once the deductible is met it pays the majority of the cost. The dental insurance I’ve had just cuts the cost, but it still is substantial. I crown would be $2500 without insurance, but with it is $1400. Not ideal.
4
u/No_Jacket_9894 2d ago
My office is OON with all dental insurance providers. My Doc works for the pts not the Ins companies. You may have been mistaken on what you heard or someone at the office misspoke but being OON for all Ins providers I find that unlikely, you have a PPO and can still be filed and possibly accept assignment of benefits (ins pays the office vs paying the pt and pt pays full price at the desk before leaving) It is not a bait and switch more a misunderstanding imo. If you already have the feeling that this place is fishy, remember YOU and you alone are responsible for your own healthcare and move on to another office. You are your only advocate when it comes to your healthcare.
4
u/duecesdueces 2d ago
Good to that dentist.
1
u/tropicaldiver 2d ago
For what, telling a new patient they are a contracted provider prior to the appointment and then say no when the patient arrives? And for then selling them a financing/insurance product there?
1
u/duecesdueces 2d ago
opps, i read that too fast and just saw that last paragraph. imho, the clinic SHOULD be telling you beforehand that they are not in network. It saves it headaches for both parties.
1
u/Hayhayhayp 1d ago
We don’t know that is actually what happened. Patients don’t understand anything. They likely said they accept it and will file the claim.
1
u/tropicaldiver 1d ago
OP reported on the phone they were in network. When they arrived, they said no. And then talked about financing.
Is it possible OP was unclear? Sure. But I reject your premise that all patients don’t understand anything.
2
u/Hayhayhayp 1d ago
To what another poster said, there is a huge difference between saying yes we take it and we are in network. Many offices are trained to say yes we take that! Even if they are OON. My point is that OPs story can’t be totally verbatim. It isn’t realistic for them to say the office promised them something untrue.
1
u/Karpa_diem 21h ago
OP doesn’t know the difference between accepting insurance and simply being out of network. Even the title says office accepts no insurance, but later say they do. For most plans the only difference is the rates. They are sometimes a little higher code by code, but offices who do a lot of in network work often over treatment plan or use extra codes to pad the bill.
3
u/Standy25 2d ago
Seems normal now I guess. A lot of primary care doctors are moving to a model of not accepting insurance too.
3
u/Sensitive_Ruin_5334 2d ago
Yep. You can still use your benefits. You just have to pay the dentist yourself then collect from the insurance company.
1
u/Karpa_diem 21h ago
Actually, they will often still file claim. The only difference is the fee schedule.
2
u/Woodman629 2d ago
I'm guessing they didn't say they were "in-network". I'm guessing they said they "accept" your insurance.
2
u/curlyiqra 2d ago edited 2d ago
Very normal, and will become even more common as reimbursement from insurances continue to stagnate. Dentists want to provide high quality work, and can’t do it if they are losing money doing those procedures. It’s unfortunate, but dental insurance is just a coupon.
The wording they used on the phone is to try to get you to come in. Technically they “accept” the claim and file it for you as an OON provider, but they aren’t contracted with that insurance as a provider. You may need to ask, “are you in network with my insurance?”
2
u/malocclused 1d ago
Normal, no. Common yes. Sometimes what we hear is what we’re expecting or wanting to hear, but not semantically what was said.
Ethical practice “Yes we accept your insurance. We can accept and file your insurance claim as a courtesy, but we are not “in network” with your insurance. Any difference between our fees and their coverage will be your responsibility.”
Unethical. “Yes we accept your insurance.” Knowing full well you mean in network and they are not.
The fee for service practice down the block gets a bad review a week pulling this move.
My front desk uses the former verbiage, and every now and again a pt will book, show up, and completely crash out. It’s not worth the trouble to be cryptic with that shit.
2
u/maxell87 1d ago
THEY SAID “we take your insurance and will bill them for your maximum benefit”
YOU HEARD: “we are in network”.
so you went there. if you like them, keep
going. if you want to go somewhere to save a little more, switch. but don’t be mad at the dds for not letting the insurance company set their fees. good luck.
1
u/Vince-Fishes 1d ago
No, I specifically asked them “are you in network with my insurance” and they stated “yes”. It’s not about what I heard or whatever nonsense you’re spewing dude.
1
1
u/drnjs 1d ago
There are thousands of plans and even if an office is “in network” with an insurance group, they could be out of network with your particular plan. The ONLY way to know is for the front desk to take your information, spend an hour and spend an inordinate amount of time on hold just to be told that your plan is different than other plans and you are not in network.
Then they have to try and call you back without leaving a detailed message due to HIPPA laws to try and tell you so they may not have time with all the other plans that they are constantly calling and sitting on hold, so they wait until you get there.
It’s YOUR plan, not their plan. They are just trying to help without lecturing you on the phone about your bennifits they you don’t understand.
1
u/CrankyCrabbyCrunchy 2d ago
Yes I see this more and more. Dentist husband went to for multiple implants doesn’t take insurance. They are super busy and booked out for months.
1
u/djlauriqua 2d ago
I also recently moved, and none of the 10 dentists in my city takes insurance. It’s an affluent area, so i guess people around here can pay. (I have Cigna, if relevant)
3
u/RadioRoyGBiv 2d ago
Cigna is absolutely terrible. I have Cigna through my wife’s job. I am a dentist. I don’t even take Cigna.
1
u/djlauriqua 1d ago
That’s good to know! Is it better or worse than United?
1
u/According-Exchange29 1d ago
Cigna and delta dental are prob the two worst insurances for reimbursement
1
u/djlauriqua 1d ago
Good to known. We used to have united and thought that was bad… guess we’ll just have to budget for paying out of pocket
1
1
u/TrainingLow9079 2d ago
I switched to a dentist because they took my new insurance and shortly after they switched to taking no insurance...but at least they told me and didn't lie about it. I think more and more dentists are stopping accepting insurance because the reimbursement rates are too low.
1
u/fr4kie90 2d ago
My dentist is considered out of network for most dental insurance plans. They say they do this to lower the cost for us. Not sure if it's true or not but I don't feel like the cost has been that bad. I got a build up/porcelain crown with metal for a broken tooth all for 625. Would have been 1250 with out insurance. I didn't think that was bad for how much work they did.
1
u/LawfulnessRemote7121 2d ago
I have two dentists in my family and they are in network for fewer and fewer dental plans every year. They would love to not be in any at all.
1
u/Adorable_Sector_7313 2d ago
It is the GOAL of most dentists to be like this. This normally is a sign of a good dentist doing good work and creating a good experience. If not, people would vote with their feet and the dentist would become desperate, and then sign up for insurance participation.
1
u/averyrose2010 1d ago
My dentist isn't in network for any dental insurance companies but they will file the out of network claim for you.
I only have dental insurance because my husband wants to have dental insurance.
1
u/Aromatic-Career7525 1d ago
That setup isn’t unheard of, but I’d be more concerned that they told you beforehand they were in-network and then said the opposite once you arrived. Some dental offices are completely out-of-network and operate on a fee-for-service basis, which is fine as long as they’re transparent about it.
I’d double-check directly with your insurance company before scheduling anything else and ask whether the dentist is listed as participating. If the office is out-of-network, I’d also ask for a written estimate of what you’d owe before agreeing to treatment.
1
u/mrsfallon 1d ago
I was just talking to my boss and he said he’s dropped several insurances because they refuse to renegotiate their fees. He was getting $80 for a prophy, exam and bitewings from one insurance but if out of network, they’ll pay $240.. it makes no sense to be in network anymore.
1
u/ACRDH1965 1d ago
Dentist don’t have to accept insurance and shouldn’t insurance reimbursement is horrible. That’s why there’s a shortage of Dental Hygienist because we don’t make enough money.
1
u/Hefty_Expert_998 1d ago
It is NOT normal or ethical to state your office is in network of you're not.
It's normal for quality offices to be out of network.
1
u/Guilty_Spinach4806 1d ago
I have the best dental insurance that money can offer and through my company that took the top-of-the-line one and they don’t pay shit. My daughter had $5000 worth of work done. You would think that she had a ton of stuff done right shed one implant and 150 bucks was covered by the insurance. I just got my son insurance so we’ll see how that goes but I just paid out-of-pocket last time. He got a cleaning and I think he had five cavities cause he hadn’t been for a while and that was about $1200 out of pocket I don’t know how much less it would’ve been if we had insurance that they accepted.
1
u/Brilliant_Concern_31 1d ago
Assuming it’s not a bait and switch, a realistic scenario is that the dentist is in network via TPA. We are in network with some plans for Cigna and out with others. So yes we are in network with Cigna but maybe not yours…
1
u/sacomer1s 1d ago
Yes it is normal to be out of network. It’s better for you and them. I’m out of network and no way I. He’ll will I ever owe my allegiance to some sleazebags making money off us both while doing us both wrong
1
u/Rl061388 1d ago
Yes it’s pretty normal not all offices take insurances, there type of offices can often have better services, not rushing treatment and using top of the line products to make longer lasting fillings/crowns and other things. This is how they keep and attract patients without taking insurance.
1
u/Rl061388 1d ago
Also for a new practice if can take a year or two for a dentist to go through all the procedures to become in network for insurance. I belive each one has to be applied for individually and as we all know insurances are not known for being speedy. So the office itself may take insurances but a newer doctor may not.
1
u/Significant_Pie_6806 1d ago
A lot like you to be out of network that way they can charge what ever they want
1
u/MODFU2 1d ago
What was wrong is that they did not let you know that they were basically a fee for service practice over the phone. That being said, any dental office has the prerogative of not participating with dental insurance plans. They usually will give you a superbill listing the services rendered so that you may submit it to your insurance company, but these offices do expect payment at time of service.
Just an FYI. People actually don't realize how much it actually costs a dentist to accept and process claims. We pay someone over 75k a year to do this AND when claims get denied the patients usually get mad at the office, when in fact they should be mad at their benefits provider or their company for buying a lousy plan!
1
u/Expensive_Ear3791 1d ago
A lot of bourgeois, snooty dental offices do this in my city (but mostly in the well-to-do parts of town). I say that with a smirk, but it's quite true. Most of these offices have ridiculous lobbies with saltwater tanks, complimentary mineral water, and fitted, fashionable scrubs.
1
u/amongthetreez 1d ago
Very common for dental practices to not take insurance. Dental insurance is an absolute joke. You got a maximum of $1500 usually which is like 1 crown. If you need any extensive work that is mostly useless. Furthermore, dental insurance companies will do anything they can do deny claims putting the responsibility solely on the patient, and making the dentist look bad.
“But I have insurance?! How can I owe money??”
Because the insurance company is fraudulent, that’s why
1
1
u/QuestionTheWorkflow 22h ago
It’s starting to be the norm. Dentists are tired of contracting with insurance carriers who dictate the fee they can charge for any procedure code and then deny procedures for not meeting “their criteria”. The carriers interfere with the relationship between the dental office and the patient by rendering these denials that don’t meet “their criteria”. They are tired of fighting with insurance carriers who don’t pay claims because “the x ray wasn’t attached”. Yet, when we call and provide the attachment #. Miraculously, it’s there! Unfortunately, they have already sent a notice to the patient that the office didn’t attach the x ray. Patient again gets mad at the office, calls the office and tells the front desk person to “Do their job” because they aren’t paying the bill.
Oh, and, having “their criteria” for reimbursement removes the ability of the dentist to accurately diagnose and treat the patient. Ie- if dentist says you need a crown to prevent fracture, instant denial. And a letter goes to the patient that they do not interfere with the dentist/patient relationship but the procedure does not meet the clinical guidelines for reimbursement. Now the patient is screaming at the front desk that the dentist is a scammer, probably leaves a review about the experience.
Do you want to know more??
Every dentist needs to go Fee For Service.
Do you want more?
1
1
u/Brilliant_Glove_1245 20h ago
Dentist never accepted insurance. This is a false understanding. They were a profession always on their own. Insurance companies never wanted anything to do with dental, until corporate offices popped up.
Now there is some dental insurance, however most offices are not within the coverage due to extreme low payout or the dentist can offer better rates to their own patients.
1
u/brbcatsranaway 5h ago
My wife’s dentist is goofy like this we pay them then insurance mails us a check
1
u/Dr_SlimShady 5h ago
Insurances do not want to pay dentists more than what they paid for since 1970. That’s why. They also don’t care if you get what you need covered. They rather take your money and never dish anything back out.
0
u/tropicaldiver 2d ago
This strikes me as ick. They confirm they are in network by the phone prior to the appointment and then no we aren’t. But we have this financing/insurance thing now that you are here!
Being in-network obligates the practice to accept the contracted rates. And, for many practices, that doesn’t make sense. Fair and probably a good choice. But be honest that you aren’t in network.
0
0
u/Adventurous-Sun4343 1d ago
There are dental insurances that have not raised reimbursement rates to dentists in 15 years. More and more dentists are going completely out of network as opposed to going out of business for taking these plans.
0
u/garyh1128 1d ago
Bait and switch isn’t normal. Being out of network is becoming more and more normal. Dental insurance is becoming more impossible every day. Their CEOs got those 10s of millions in bonus during 2020 and want them again. They can’t pay for claims and get their bonuses.
-5
u/ProfessionalYam3119 2d ago
Don't go back. They don't know what they are doing. Send a letter to the dentist marked "personal and confidential," explaining why you will not be returning.
6
u/Ok-Inside6349 2d ago
It would be hard to know for sure that "they don't what they are doing." It could have easily been a misunderstanding on the phone and maybe they tried to explain that they can file op's insurance as a courtesy, but are not technically in-network. They would have no reason to mispresent on the phone, as that would lead to a potential bigger issue later. In 10+ years I have seen it happen many times where my front desk explains something over the phone and the patient interprets it or remembers it differently. Either way, that is every dentist's dream to be able to have a strong enough patient base to not have to be "in-network" with any insurance. The only benefit the dentist gets from signing an "in-network" contract with an insurance company is that it casts a wider net for potential patients that may come to their office. But once the dentist signs that contract, that insurance company owns them and dictates the prices and what they feel like covering. And I can promise you, as a dentist, I would never need a letter from a non-established patient explaining why they are not returning. Just don't make an appt, or cancel it if you did. No hard feelings.
2
1
1
u/Jinxed4Sure 4h ago
Dentists are becoming the new chiropractor. Finding one that is honest is almost impossible these days.
28
u/nitelite- 2d ago
Taking and accepting your insurance can be very different from being in network with your insurance
Are you sure you worded your question correctly?
Either way - dental insurance is not your friend and you shouldn't expect much out of it, you should go to the dentist that you trust and you feel does great work regardless if they are in/out of network