- 30,259
I've had mine for 6 years and it covers actual charges. You must've taken yours right after they switched to usual and customary.
Does Aetna offer individual dental plans?
- Thread starter yorkriver1
- Start date
- 6,965
do you see reasonable Ameritas networks in your area?
You must be looking at the Select plan.. The original plan is still available.
- 6,965
ok thanks. I'll try to remember that as I look for their brochure.
My dentist doesn’t take many plans, including Manahattan, but he takes Ameritas. It’s not the biggest network here but it’s pretty strong.
- 6,965
Thanks.
And that certainly would make Ameritas a good deal for you--I think they have lower cost options compared to some other plans. I think I only have one in-network Ameritas provider within safe (for me) driving distance of my home so I have to look at other options.
I vaguely remember Scott talking about Ameritas several years ago while he was still in Ohio and he liked their networks there.
Does he take cash? Manhattan allows the patient to use any dentist. No network required.
- 6,965
Two "other sides" to that are:
If his dentist is in-network with Ameritas, he will get a re-pricing benefit in addition to the cash payment to the provider.
We don't know background to Chazm's denials comment. $0 cash payments on denied claims would be a challenge.
Patrick Flammia
Expert
- 44
I don't understand the re-pricing benefit. Are these pre negotiated rates between the insurance company and the dentist? I would imagine the cash price with any dentist would be less than whatever the "negotiated" rate is. Also you say the repricing benefit in addition to the cash, does that mean the dentist is double dipping?
I'm just trying to become a believer in at least one company I can sell and not feel like I'm ripping someone off. The more I look into this though, the further away I seem to get.
- 6,965
This is going to be a little bit confusing because this is the first (only) basic services claim I had for 2022.
This is for a resin (white) one surface (d2391) filling on a molar. (UHC EOBs give me that info.)
The dentist charge to me was $180. Goillini or Rousemark would have to tell you how that would be handled and paid with Manhattan.
I currently have two dental insurance plans. A $1,000 UHC plan which I started before UHC split their dental plans into under 65 and 65 and older. My plan is basically equivalent to a $1,000 under 65 plan and I could not buy it today.
The UHC plan is primary. Secondary I have BCBSKS higher (of two) priced senior plan.
Both are non-employer individual type coverage.
Dentist charged $180. UHC allowed $86. (That is probably UHC's allowance for a silver filling on posterior teeth.)
I had one dentist (who has since fired me) who is in network with UHC but would not accept UHC's payment for a silver filling on posterior teeth as payment in full for that filling. They had me sign a paper saying I would be liable for full difference between their billed price and UHC's payment amount.
Dentist charged $180. UHC allowed $86. Regardless of how the payment may have been calculated, this dentist accepted the UHC allowance, so my maximum liability for this filling is $86. So my Dental INSURANCE payments reduced my liability to the dental practice by $94.
Since this was my first basic service of the year, UHC subtracted a $50 deductible from the $86, leaving a balance of $36. My share of that is $21.30. UHC paid the dentist $14.70. I owed the dentist the $50 deductible plus my share of the after deductible amount, $21.30, for a total liability of $71.30.
My UHC dental ins premium is approx $35/mo. I also have a UHC vision plan (I've never used) which is a bit over $10 per month.
Lots of folks would look at the info 2 paragraphs above and say, "So your insurance paid $14.70. Big deal. I look at it and say I got $94 + $21.30--maybe 3x my monthly dental premium--maybe 2x the sum of my monthly dental and vision premiums.
Now it gets more complicated. I have secondary ins. BCBSKS.
Dental charge $180. BCBSKS allowed $136.91. They subtracted a $50 deductible, leaving a balance of $86.91. My co-insurance share of that was $17.38. Their co-insurance share of that was $69.53. BCBSKS paid the dentist $69.53.
So my final liability to the dentist was $180 minus UHC network pricing adjustment $94 minus UHC payment $14.70 minus BCBSKS payment $69.53 = $1.77.
If I would have had additional fillings in 2022 I would probably have had small credit balances in the dentist's books for each additional service. Hard to say for sure because the UHC dentist charge to UHC allowed amount difference would not be as large for resin fillings on anterior teeth.
If the dentist did not accept UHC, but accepted BCBSKS, then BCBSKS' allowed amount would have been the cap and I would have been liable to the dentist for the BCBSKS allowed amount less 1 $50 deductible and the payments from UHC and BCBSKS.
Re ripping someone off, you should reread through my previous post.
I'm guessing you either see Dental INSURANCE as a reimbursement plan, or you do not believe the CASH payments to a dentist are worth the premium one has to pay to get them. If one of those is your belief, you will not find value in Dental Insurance. If you do not find that value, then you will have to decide whether or not to just choose some dental coverage and say to your clients something like: I do not personally believe in Dental insurance, I do have this option you can take if you wish. Here is the literature, check it out and let me know if you think that will be useful to you."
If I was an agent in the Senior Market space and wanted to sell dental insurance I would be looking at UHC and BCBSKS. If BCBSKS does not allow selling by independent agents, I am not sure what direction I would then go for a second choice. I would probably also talk to a CSR with Sam's NCD company and see what I thought of that coverage.
This is for a resin (white) one surface (d2391) filling on a molar. (UHC EOBs give me that info.)
The dentist charge to me was $180. Goillini or Rousemark would have to tell you how that would be handled and paid with Manhattan.
I currently have two dental insurance plans. A $1,000 UHC plan which I started before UHC split their dental plans into under 65 and 65 and older. My plan is basically equivalent to a $1,000 under 65 plan and I could not buy it today.
The UHC plan is primary. Secondary I have BCBSKS higher (of two) priced senior plan.
Both are non-employer individual type coverage.
Dentist charged $180. UHC allowed $86. (That is probably UHC's allowance for a silver filling on posterior teeth.)
I had one dentist (who has since fired me) who is in network with UHC but would not accept UHC's payment for a silver filling on posterior teeth as payment in full for that filling. They had me sign a paper saying I would be liable for full difference between their billed price and UHC's payment amount.
Dentist charged $180. UHC allowed $86. Regardless of how the payment may have been calculated, this dentist accepted the UHC allowance, so my maximum liability for this filling is $86. So my Dental INSURANCE payments reduced my liability to the dental practice by $94.
Since this was my first basic service of the year, UHC subtracted a $50 deductible from the $86, leaving a balance of $36. My share of that is $21.30. UHC paid the dentist $14.70. I owed the dentist the $50 deductible plus my share of the after deductible amount, $21.30, for a total liability of $71.30.
My UHC dental ins premium is approx $35/mo. I also have a UHC vision plan (I've never used) which is a bit over $10 per month.
Lots of folks would look at the info 2 paragraphs above and say, "So your insurance paid $14.70. Big deal. I look at it and say I got $94 + $21.30--maybe 3x my monthly dental premium--maybe 2x the sum of my monthly dental and vision premiums.
Now it gets more complicated. I have secondary ins. BCBSKS.
Dental charge $180. BCBSKS allowed $136.91. They subtracted a $50 deductible, leaving a balance of $86.91. My co-insurance share of that was $17.38. Their co-insurance share of that was $69.53. BCBSKS paid the dentist $69.53.
So my final liability to the dentist was $180 minus UHC network pricing adjustment $94 minus UHC payment $14.70 minus BCBSKS payment $69.53 = $1.77.
If I would have had additional fillings in 2022 I would probably have had small credit balances in the dentist's books for each additional service. Hard to say for sure because the UHC dentist charge to UHC allowed amount difference would not be as large for resin fillings on anterior teeth.
If the dentist did not accept UHC, but accepted BCBSKS, then BCBSKS' allowed amount would have been the cap and I would have been liable to the dentist for the BCBSKS allowed amount less 1 $50 deductible and the payments from UHC and BCBSKS.
Re ripping someone off, you should reread through my previous post.
I'm guessing you either see Dental INSURANCE as a reimbursement plan, or you do not believe the CASH payments to a dentist are worth the premium one has to pay to get them. If one of those is your belief, you will not find value in Dental Insurance. If you do not find that value, then you will have to decide whether or not to just choose some dental coverage and say to your clients something like: I do not personally believe in Dental insurance, I do have this option you can take if you wish. Here is the literature, check it out and let me know if you think that will be useful to you."
If I was an agent in the Senior Market space and wanted to sell dental insurance I would be looking at UHC and BCBSKS. If BCBSKS does not allow selling by independent agents, I am not sure what direction I would then go for a second choice. I would probably also talk to a CSR with Sam's NCD company and see what I thought of that coverage.
