Dental Fees- Customary and Reasonable charges website for consumers?

LostDollar

There's No Toilet Paper- on the Road Less Traveled
5000 Post Club
6,408
Kansas
I wondered if there are any consumer accessible websites that list reasonable and customary charges for dental service codes by geographic areas (Kansas is my interest) that can be accessed by consumers.

That's my question. Reasons are below in more detail, but not necessary to read to know my basic question.
--------------------------------------------------------------------------------------------------------------------------------

My dentist is retiring, which leaves me with two financial issues. He has moved his files, and some of his staff who wanted to continue working, to an established multidentist practice. The practice took on a new graduate to deal with the client influx from my retiring dentist.

The first problem, for me, is that this "new" dentist office charges more for all procedures than my old dentist.

For example, after my first visit to the new dentist, I find I need 3 fillings at a cost of $30-$35 more apiece than the old dentist charged, before any insurance adjustment.

The second is a "new" wrinkle to me in dental pricing. The new dentist office has a fee for a dental code--period. They will file insurance for the patient, but they will not write the charge down to the insurance "allowed" amount. The patient remains responsible for the balance, so that the dental provider receives their full payment. For the last 30 years I have been used to the concept of having Dental Insurance, using an In-Network provider and having my financial obligation reduced to the insurance company's reasonable or allowed charge. Apparently no-longer.

There are several dentists officing fairly close to my home. Some of them have rather nebulous language on their websites, but after careful reading, I think most of them follow the same practice of holding the patient responsible for the full charge billed by the office. That appears to be a current dental "revenue enhancement" process.

The only idea I can come up with for "cost control" is that I am going to have to drive around to a few of these offices with a list of a half a dozen codes for semi annual services and simple fillings that I use regularly, find out whether they expect full payment of their billed charge when the patient has insurance, and get their prices for those services I use regularly.

Which takes me back to the question I asked-I would just like an external point of reference for the process.
 
If the dentists are in a network, they aren't allowed to balance bill over the agreed network pricing for the carrier. If they are not in network, then they can charge whatever they want. Fair Health is a sort of Kelly Blue Book of UCR pricing, but not all providers or insurers use it. Some that do make that statement up front.
If you want to have a limit on billing, match providers with the plan network you are in.
 
The Truth About Dentistry

There is an article in the current Atlantic magazine about a young dentist who bought a practice and found the seller had been overtreating patients. Worth a read before you shop for a new dentist.

BTW, I have a very good policy I got through the VA sold by MetLife, if you are eligible.
 
There is an article in the current Atlantic magazine about a young dentist who bought a practice and found the seller had been overtreating patients. Worth a read before you shop for a new dentist.

BTW, I have a very good policy I got through the VA sold by MetLife, if you are eligible.
Thanks for the posting the article. My wife had dentist that recommended a lot of work, suggested she see my dentist & my dentist recommendations were very different.
 
Two companies, MetLife and I think Delta, offered coverage to veterans who were already in the VA system. I went w MetLife because my dentist is in their network. They had 2 options, I went w the higher that has a $3k annual max, being an escaped dental patient, moi. I pay $107 monthly for myself and wife. Two cleanings a year w no copay, etc. the network pricing makes it worthwhile. Interestingly, the dentist told me he wouldn’t join UHC’s network because they pay too little.

This was a pilot program started about three years ago. I assume it is sustainable for MetLife because they haven’t ended it.
 
Last edited:
Two companies, MetLife and I think Delta, offered coverage to veterans who were already in the VA system. I went w MetLife because my dentist is in their network. They had 2 options, I went w the higher that has a $3k annual max, being an escaped dental patient, moi. I pay $107 monthly for myself and wife. Two cleanings a year w no copay, etc. the network pricing makes it worthwhile. Interestingly, the dentist told me he wouldn’t join UHC’s network because they pay too little.

This was a pilot program started about three years ago. I assume it is sustainable for MetLife because they haven’t ended it.

I am finding there are some circumstances where UHC's network pricing can be avoided (by the dentist).
For example. They split the mouth into anterior and posterior teeth. UHC will not pay for the white resin fillings on posterior teeth. They only pay for amalgam fillings. the insured is obligated to the dentist for any difference between the amalgam and resin fillings.

So this new dentist only does resin fillings. They charge more than the old dentist. So I get a resin filling in a molar. I get to pay my deductible plus the full difference between the dentist's resin charge and UHC amalgam allowable.

This essentially leaves half the teeth in my mouth without any network payment cap for fillings under UHC insurance. Sounds like a good deal for the dentist to me.
 
Back
Top