It is a hassle to price shop a dentist but it’s worth it if you’ll stick around a while
Hi Friendos,
I’ve written quite a bit about my recent deep dive into dental insurance and today am going to wrap it up with a discussion of the cost of basic teeth cleanings. I know, not everyone has coverage for those luxury bones! I am thankful to have employer-provided dental coverage through my spouse’s job, and it works just like what I had through my own prior employers for many years. There is an annual coverage limit that caps the amount the insurance company will pay for in any given year (I wrote about that here), so if you can get your routine cleanings to use up less of your annual allotment, that leaves more “room” for non-routine things you might need, like having a cavity filled.
Last month I also wrote about how dental insurance has in-network and out-of-network dentists, but not all in-network dentists are the same when it comes to pricing. This impacts how much of your annual coverage is used up with each dental visit. I also wrote about how out-of-network dentists may tell you “yes, we take your insurance,” and this also impacts the amount of your annual coverage limit that is eaten up with each dental visit.
Today I can report back to you with some interesting details on pricing for a regular teeth cleaning. This is just a handful of data points, but I’m sharing it because I suspect it’s typical and representative of what you will find if you have dental insurance and do the same research.
First, I looked at some old paperwork from semi-annual cleanings and figured out some key dental billing codes. I present to you…
- D0150: “Comprehensive oral evaluation – new or established patient.” The cost of a first-time exam by a dentist when you go for a teeth cleaning, or if you haven’t been for an exam in a while.
- D0120: “Periodic oral evaluation – established patient.” The cost of the dental exam when you’ve already been to that dentist and have had regular visits.
- D1110: “Prophylaxis – adult.” The cost of the actual cleaning work done by a dental technician.
I called Cigna, my dental insurer, and asked how much of my $2,000 annual allotment would be used for each of these billing codes with three different dentists.
- The dentist who owns the practice at my long-time dental office. She is in-network for my insurance with “Preferred” status, but has no rating from Cigna for “affordability.”
- A less-experience dentist at my long-time dental office who is in-network with my insurance but not “Preferred.” Affordability, also “NA.”
- An experienced dentist at a different office who is in-network and preferred. Cigna rates him 10 of out 10 on affordability.
Cigna people explained that even if the same dental tech did the cleaning, the billing cost for their cleaning work would be tied to the network status and contractual rates of the dentist who did the exam.
Here are the results:
The yellow highlighted row is saying: If you have my insurance and are going to one of these dentists for the first time (ever or in a while), you would use up $244, $475, or $112 of you $2k annual coverage for a semi-annual cleaning and comprehensive exam.
The green row gives the amounts for a cleaning and follow-on exam. You can see that with two cleanings and exams a year, Dentist #2 has already used up more than $900 of my $2k annual coverage limit, so if I need a cavity filled or anything else, I’m pretty likely to have to pay out of pocket for the amount exceeding $2k. With Dentist #1 I’m more likely to be fully covered, but I like the odds with Dentist #3 the best.
So…why doesn’t Cigna publish this info on their website, where I could easily find it? They don’t really care if they have to pay out more – they just increase premiums accordingly. That means more of my spouse’s compensation bypasses his checking account and goes right to Cigna. And if I exceed my $2k annual coverage limit…that’s my problem, not Cigna’s problem.
I find this whole situation totally out of hand, but we have to engage in financial self-defense where we can. I scheduled my next cleaning with dentist #3. If that office is well run, I’m likely to keep going there for a long time, making this research worth it. If not, maybe a few of you got something out of it!
-Stephanie
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