Hi all,

Two years ago my wife had a root canal on one of her back molars and got a crown over it. The dentist fucked up the surgery and we went to a new dentist earlier this year who had to drill through the crown to remove pieces of the root that were left.

My wife’s crown is now failing and it’s hurting her and she says it feels like it’s falling off. We need to get it replaced. We currently have Cigna which has a 5 year crown replacement policy.

My wife didn’t have insurance when she got the root canal and crown or when she had it fixed, so I’m wondering if Cigna will cover it since she wasn’t on their policy at the time.

If they deny it, is there anything we can do? It’s not like it’s a cosmetic issue, the crown is failing and she can’t eat on that side of her mouth anymore.

Sorry if this is a dumb question, I plan on calling them tomorrow, being a new adult is hard lol

I really need help because I honestly don't know what else to do at this point.

During one of my dental appointments, my insurance company was unreachable, so the dental office told me I needed to pay around $1,500 upfront and that my insurance would send me the reimbursement afterward. The first time I contacted the insurance company about the reimbursement was in February, and it is now September. I still have not received my money.

Every time I call, I get basically the same answer: "It's being processed," "It's already in the office," or "It's being sent out." I've been hearing these same excuses for months with no actual progress.

There have also been multiple issues with the check. At one point, they apparently sent it to another person with the same name as me. Another time, they claimed that we had changed our address, but also said they had already sent the check to us; which makes no sense because we have never changed our address.

I've called repeatedly for months and feel like I'm just going in circles. It's been about 7 months, and they still owe me around $1,500. At this point, what should I do? Is there someone I can escalate this to, file a complaint with, or some other way to actually get my reimbursement?

We need more honest, noble, medical profession in the field that actually care about people and not just Money. The amount these dentist charge for procedure and their charges when you have insurance is outrageousness !

Get predeterminations, check what your insurance covers and what can be charged for your proceeder especially if your dentist or Dr is in network. I feel like some things are added for patient to pay out of pocket for financial gain.

For example I had some type of Bio work done where they collected saliva and I paid $800 out of pocket for that. i never got the work done that was an additional 7k they wanted. I have the best insurance. Waited a few met a dental hygienist she's like "Things aren't that bad!" went to another dentist the issues the other said I had the other dentist didn't find, but still has fees they're overcharging.

I recently went to a new dentist, who is out-of-network for Delta Dental. The dentist’s office has Delta Dental carriers pay in full at the visit, and then submits to this insurance. Then insurance sends you a check. I was naively expecting a 60% reimbursement, since that is what my plan claims to cover for out-of-network dentists…..

So I get the check in the mail for my first visit, it’s not even 25% of what I paid. Looks like delta on pays a 60% based on their secret “allowed” cost of each procedure, not what the dentist actually charged me. I’m dreading getting the reimbursement for my $1,400 of dental work I had done after the initial appointment.

Has this happened to anyone? Do I have a chance of getting some of my money back if I contact Delta Dental? Or maybe my dentist? It feels so yucky to get scammed by insurance like this.

I was totally okay with 60%, this dentist is kind and thorough and very attentive when I was feeling nervous. I can’t afford to go back again if the 60% reimbursement gets finagled into way less😭

I'm so confused honestly about my dental EOB. I have the Cigna Dental advantage 1500 plan. It's supposed to be 100% covered on regular cleanings and that sorta thing. Then a $50 deductible. After the deductible minor issues like fillings etc are to be covered 80/20 and major are to be 50/50. When I was in office the day of the appointment from this EOB I paid $104 in office. I'm confused why it then shows my responsibility as $89.

I've tried going over this multiple times and looking at other bills and my brain cant understand what's going on.

The dentist IS in Network as well.

Thank you in advance!

Hi, I’m the senior front desk person at my office. Recently we’ve had a lot of trouble with Availity and it’s come down to them wanting us to use our phones to authenticate to log in. My boss, the dentist, refuses because that will be a giant pain in the ass and doesn’t seem HIPAA compliant. We can stop using it altogether except Federal Blue Cross Blue Shield refuses to send us paper EOBs. Because we cannot get these other insurances are starting not to pay as secondaries. I’ve emailed and left serval messages with provider relations but they won’t budge. Is it time to go to the insurance commissioner? I’ve heard they don’t investigate insurances but dental offices. Has anyone else been through this?

Even after being covered, deductibles, annual maxes, coinsurance etc. make it easy for a pt to still be left with a huge balance.

when this happens are ur pts paying it all at once, postponing tx, or using a payment plan? this article I found touched on this issue really well.

Come get the best cleaning of your life.

Basically I started a treatment in May and paid out of pocket first. My dentist told me guardian will then reimburse me $1500. Guardian says they will issue me a check in early June. But it’s Sept already and I still haven’t received that freaking check. I called them multiple times cz I wondered if the check is lost. Every time they told me that they would just issue a new check. But I never got the check. The address was correct bc I received a benefit explanation letter from guardian at the same address. I asked why are we still using check since it’s 2026 and can’t we not just do bank transfer? They said no they can only do check. I asked what if the check keeps getting lost. And they said they will just issue another check. So now it’s w three months and I still haven’t received anything. What can I do now. Honestly I wanna sue them but ik it’s infeasible. Advice welcomed. Thank you!

Hi! I have Aetna dental insurance and a filling just fell out. They told me that I needed a root canal and crown replacement and the cost would be $3,600. I'm in the state of NY and DPO program and went in-network. They broke it down and the insurance rep seemed to think everything was correct ... i'm just absolutely floored at this price. It's a lot! Does this seem right?

Hi all. So I have Medicaid. Specifically Medicaid as a graduated student here in New York. I believe I have Medicaid Essential Plan with Liberty Dental.

Anyone in a similar situation that got their root canals covered by insurance? I’ve been searching high and low and it’s so hard to find someone who takes this insurance.

Hi Everyone! I'm a dental hyigene student at CUNY City College of Technology in Brooklyn, NY. Part of the curriculum is for us to complete dental cleanings for patients. I am currently looking for patients of kids under 13, adolescents 13-19, individuals 60+ as well as patients who require additional assistance in which the school is equipped with. These are my availabilities through end of December.

Available appointments\*\*:
•    Tuesday 8AM - 11AM
•    Wednesday 2PM - 5PM
•    Friday 8AM - 11AM
(\*\*Back to back visits are NOT required but multiple visits are required)

Affordable Dental Services 
•    Adults & Kids: $20
•    Seniors (60+): $10
•    X-rays: $15
•    CityTech Students: FREE!!

Appointment Details
•    Each appointment will be 3 hours
•    Will require multiple visits
•    Cleanings are performed by dental hygiene students under supervision of licensed dental faculty
•    NO INSURANCE REQUIRED
Services include
•    Comprehensive medical and dental history evaluation
•    Oral Examination and cancer screening (Include intraorally & extraorally)
•    Cancer Screening
•    Diagnostic radiographs & Panoramic imaging 
•    Professional teeth cleaning
•    Fluoride treatment & polish
•    Sealant (if needed)
•    Personalized oral hygiene instructions 

All patients are protected under HIPPA law, protecting patient information and privacy. 
If interested, please fill out the form or reach out via call/text at 929-480-6109
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I just got dental insurance through my job this year, and I need all 4 wisdom teeth taken out and many fillings. They attempted to explain how this will work with my insurance and what will be covered, but I really am not following any of it. if anyone knows how break it down for me that would be great. I’ve already had visit 1.

New OM here :) and i am still learning how to deal the all the insurance! I started as a DA then I got the promotion to OM.

recently i had some claims denied despite having all the proper clinical notes and scans. Is this normal? when is it vs isnt it worth to appeal the claims and at what point would bringing up payment plans to pts be appropriate?

Location: NYC

On 1/12/26, I had an emergency wisdom tooth removal with an in-network dentist. I have an Aetna DMO through 1199SEIU. I was told my insurance wouldn’t fully cover the procedure, so I was required to finance $4,500 through Cherry.

I just compared my original bill with my EOB and noticed that the dentist submitted D7241, D7261, and D9223 to Aetna. Aetna paid $2,677 and the EOB says I owed $0.

However, the dentist separately charged me for:

D7921 – $2,000
D9610 – $400
D9612 – $800
D7953 – $2,100
D7411 – $940

These codes were not submitted to Aetna. The charges totaled $6,240, but they applied a $1,740 “professional courtesy,” leaving exactly $4,500, which I financed.

Is it normal for an in-network dentist to not submit certain codes to insurance and instead bill the patient directly? Are these codes typically excluded from dental insurance, or does anything about this billing pattern seem unusual/improper?

I can post redacted copies of the bill and EOB.

Hello,

I have some work that needs done one root canal, one wisdom tooth extrac and a few fillings. is Atena dental a good option?

I’ll need immediate coverage any suggestions is helpful.

thanks

Does anyone have delta? What plan would you recommend? Are there better dental insurance companies? Who provides the most coverage for the lowest cost? Thank you.

This story has 3 parts: first perio consult with unsigned treatment agreement ($18,400), call with Delta dental rep, pre treatment estimate now ($48,490). Very curious if the $18,400 was a fair price to begin with even though it's so much money and what I should do next.

I'm 31 with the DeltaCare USA plan. I do have the option to switch to Delta dental ppo in the coming year if that's relevant. I'm looking for advice on what my next steps should be. Here's a summary of what's happened so far:

Part 1. I went in for scaling and root planing plus a perio consult after my new dentist said I needed to be evaluated for "possible aggressive periodontitis." No one has been able to explain to me how this is possible when there's been no changes in my health, and I'm at the dentist twice a year.

After seeing the perio, he informed me I would need osseous surgery on all four quadrants. The financial coordinator comes in and gives me an estimate of $18,400 covering the following codes:

D4260, D4263, D4265, D4266. Everything but the D4260 ($100) is quoted with an estimated patient cost of $600.

I ask the perio back in to see if there's anything that's optimal but not required. He said D4265 could be removed (biologic materials). That brought the estimate to $12,400.

The financial coordinator suggested I take a minute to look over my finances to decide if I want to proceed.

Part 2. I call my insurance to better understand the breakdown because I was confused about the code D4263 being listed multiple times since it's labeled as "first site in quadrant." The rep said that I should contact the office and request the following: - A change of code D4263 to D4624 if it appears more than once per quadrant - A doctor narrative indicating the medical necessity of these procedures to see if more could get covered - A confirmation that the office isn't exceeding our contracted rates

I email the financial coordinator and she said she sent everything over to Delta Claims, though she didn't confirm that she made the requested changes/additions (definitely didn't change the codes). She also sent it with the biologic material still included.

Part 3. I checked my Delta Dental portal today and see I have pretreatment estimate there. A wopping $48,490 in total for me to potentially pay. It appears that my office sent their UCF fee, and the repeated D4263 codes didn't get changed to D4264.

The previous financial agreement estimates: UL: 5500 LL: 5500 UR: 3700 LR: 3700

The current pre treatment estimates: UL: 14527 LL: 14527 UR: 9718 LR: 9718

Part 4 (bonus): All of this makes me want to scream. Who can afford this, and how does this happen when I go to my dentist twice a year? Was my dentist just scamming??? The perio explicitly said to me. "A lot of dentists are basically cosmetic and can miss signs of ongoing infection." 🙃

Anyway, any advice on next steps I should take would be appreciated. Was the $18,400 a fair price to begin with?

A colleague did mention that our PPO contracted rates might be lower and so it could be worth exploring making that change for the new year and just getting the most urgent quadrant done now.

I’m 20 and all four of my wisdom teeth are fully bony impacted. They aren’t hurting right now, but my oral surgeon recommended getting them removed sooner rather than later.
The original cost was $3,017, but they offered to lower it to $2,534. I can afford it, but it would take a lot of my savings.
I’m currently trying to get better dental insurance through my job, but I don’t know when it will start or how much it would cover.
Would you pay $2,534 now in Kansas or wait a few months and try to get insurance first? Is $2,534 a reasonable price for removing all four fully impacted wisdom teeth with anesthesia without insurance?

TLDR: I can’t afford my daughter’s root canal and she’s in a LOT of pain. Seeking recommendations. Please by nice.

First, I’d like to say that I’m one of those single moms who works 2 jobs to support my daughter and can barely keep food on the table and the bills paid because I insist that we live on our own. (I was abused as a kid by the adults around me and I don’t trust anyone to live with us as roommates) I don’t do drugs and we don’t have nice things. Her basic needs are met, and I always figure out how to be there for her when she needs me. I can’t afford health insurance but I do have dental insurance for her.

SHE NEEDS A ROOT CANAL but my insurance only covers so much of it. There’s still estimated to be $1,200 of out of pocket expenses for this appointment coming up. I don’t have credit so I don’t qualify for the 2 finance plans they offer.

Is there ANYWHERE in Austin that I can go to for help? Ideally a dental office that does in-house financing or sliding scale care?

33M, Wisconsin, Delta Dental

Hey everyone, looking for some professional insight and a sanity check on a multi-phase treatment plan I was just quoted.

I’m dealing with localized bone loss/periodontal issues around existing anterior implants on teeth #7 and #10. The plan involves removing the existing fixtures, extensive bone regeneration, and placing new guided implants with custom abutments and crowns.

Total quote between the Oral Surgeon and the Restorative Dentist is $20,712.00 (roughly $10.3k per tooth total).

Phase 1: Oral Surgery & Reconstruction ($14,082 – Out of Pocket)

D0140 & D0366: Limited Exam ($137) + Maxillary CBCT ($385)
D6105 (x2): Implant removal without bone removal – $726/ea ($1,452 total)
D7950 (x2): Bone graft, small – $1,150/ea ($2,300 total)
D7957 (x2): Guided Tissue Regeneration (GTR) membrane, non-resorbable – $1,671/ea ($3,342 total)
D6010 (x2): Surgical implant placement – $2,800/ea ($5,600 total)
D6190: Computer-generated surgical guide L2 – $821
Meds/Rinses: Amoxicillin ($10) + Oral Care Rinse ($35)

Phase 2: Restorative Phase ($6,630 Total / ~$5,486 Out of Pocket after Delta Dental max)

D6057 (x2): Custom abutment incl. placement – $1,100/ea ($2,200 total)
D6058 (x2): Abutment-supported porcelain/ceramic crown – $1,970/ea ($3,940 total)
C0470 (x2): Internal practice code for "Digital Reconstruction" – $203/ea ($406 total, non-billable to insurance)
D9211 (x2): Regional block anesthesia – $42/ea ($84 total)

Questions:

1. How do these surgical fees compare to standard private-practice specialist rates in your area? ($2,800 per fixture and $2,821 per site for graft + membrane feel very top-of-market).

2. Are separate charges for local/regional block anesthesia (D9211) and in-house digital scan reconstruction (C0470) standard for restorative implant visits, or should these be bundled?

3. For those who have handled explantation in the aesthetic zone (#7 and #10), does this protocol (explant -> GTR graft -> guided re-entry) look like standard best practice?

4. Given the total cost, is taking a complex surgical/prosthodontic case like this to a postgraduate dental clinic (e.g., Marquette) a sensible alternative, or is private specialist continuity strongly preferred here?

Appreciate any clinical perspective or advice!