I have an insurance ?. I'm confused!

**nodmicks** · 07-19-2007, 08:34 PM

We got papers today on our dental ins changing. I had 3 plans to pick from. Only one had orthodontal care. Since kiddo needs braces in the next few months thats the plan we need. I'm confused. At the top it says:

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deductible $50 per person or $150 per family.

deductible waived for type 1 and type 3 services.

annual maximum $1000

orthodontic lifetime maximum $1000

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Lower it says orthodontics care in network covered at 50%

So does the $1000 life time maximum mean they will only cover $1000 in kiddos life time of only $1000 will ever come out of my pocket???? I sure hope it is the later because kiddos braces are estimated at a tad under $6000 and under the plan this is replacing we paid $2700 and they paid the rest.

**Neeley** · 07-19-2007, 08:45 PM

Normally that means they will only cover $1000 of orthodonic care in the person's lifetime - the remaining balance is not covered. We have been having this same discussion this week on another forum I participate in - I feel like I am experiencing deja vu - lol.

**claimsgirl66** · 07-19-2007, 08:49 PM

Yes, I agree with Neeley; they likely cover 50% of the actual costs from the orthodonist, up to $1,000 per persons lifetime. And it does not take much to get to that 1000. I guess you need to see how much more per month the plan with ortho is, and then if it is worth it. Good luck!

**nodmicks** · 07-19-2007, 08:55 PM

Thanks!

Oh crud!!!! The old ins is much better then! I paid the first 2700 and they paid the balance up to the 6000 so 3300!!!!!!!! The new ins plans are all more expensive also. Only $5 a week or more depending on the plan but still. More money and less ortho coverage.Actually the plan with the ortho is 11.33 and without 14.33 a week. Odd.
Heavens I think that $1000 annual maximum would mean they would only pay up too 1000 a person per year also the? Heavens I had my first crown a few months ago and that was 1500. I crown would wipe out the yearly maximim! EEEKKK

**Buckeye5** · 07-19-2007, 09:05 PM

DD#1 had braces many years ago, and our insurance had a $1500 maximum lifetime for ortho care. We did have to finance the rest through a company that was set up with the orthodontists office. If you know which doctor you will be choosing for ortho care, call and ask them about the financial plans and costs. They should be able to help you with those questions. The $150 deductible is probably for any care like a filling or someting , you would have to pay $50 1st and insurance coeverage plan kicks in for the rest. Example: if bill is $100, you pay the $50, and then the coaverage plan you have kicks in for the other $50, also, max. $150 say if you have more than 3 family members in your plan, and 4 of them need a filling or something you would only have to pay the $150 total deductible and not the other $50. I helped in some way, and I didn't totally blubber you up here.

**nodmicks** · 07-19-2007, 09:11 PM

Thanks buck eye! This stuff really confuses me. Dh has been seeing an orthodontist every few months to evaluate. The ortho hasn't charged us for these visits over the last 18 months. He already let me know due to the severity of the jaw mis alignment and the teeth the bill will be just under 6000. Looks like on the new ins we only had 3300 out of pocket instead of 5000. Wow!!! Since the new dental is a ppo plan I wonder if we will even be allowed to continue with that orthodontist. I hope so!

Then lady says they do an in office finance plan with 0 % interest with $1000 down and if you pay your part in full up front they take 10% off the total bill.

**Grayce** · 07-20-2007, 12:09 AM

The annual max. for dental care isn't very high. I had a $1000/year plan and a checkup/cleaning and root canal used up pretty well the whole thing. I had to wait until the next calander year to get the rest of the work finished. If there was a plan that had a higher $ for dental care but didn't include orthodentist I would be inclined to go for that since the $1000/lifetime that the one plan covers isn't really all that much. When my Dd got braces we paid $300 for lab work/x-rays and $600 down right away. There's almost the whole $1000 used up. We are paying $200 per month for 24 months to pay the balance.

**dcompton** · 07-20-2007, 12:17 AM

I thought my health insurance was confusing until I started trying to figure out the dental insurance! I more or less gave up and just let the dentist's office file and then pay them whatever the insurance doesn't. And it's stairstepped in confusing ways with even more confusing rollovers. I don't understand why it has to be so complicated. Sometimes I wonder if it's all smokescreen, but probably there is a legitimate reason for it.

**nodmicks** · 07-20-2007, 08:05 AM

Originally Posted by nodmicks

Thanks buck eye! This stuff really confuses me. Dh has been seeing an orthodontist every few months to evaluate. The ortho hasn't charged us for these visits over the last 18 months. He already let me know due to the severity of the jaw mis alignment and the teeth the bill will be just under 6000. Looks like on the new ins we only had 3300 out of pocket instead of 5000. Wow!!! Since the new dental is a ppo plan I wonder if we will even be allowed to continue with that orthodontist. I hope so!

Then lady says they do an in office finance plan with 0 % interest with $1000 down and if you pay your part in full up front they take 10% off the total bill.

OOPS! It's not dh seeing the ortho it is DS.

**nodmicks** · 07-20-2007, 08:10 AM

Originally Posted by Grayce

The annual max. for dental care isn't very high. I had a $1000/year plan and a checkup/cleaning and root canal used up pretty well the whole thing. I had to wait until the next calander year to get the rest of the work finished. If there was a plan that had a higher $ for dental care but didn't include orthodentist I would be inclined to go for that since the $1000/lifetime that the one plan covers isn't really all that much. When my Dd got braces we paid $300 for lab work/x-rays and $600 down right away. There's almost the whole $1000 used up. We are paying $200 per month for 24 months to pay the balance.

Yeah your ight that $1000 isn't very high. Out of 3 plans 1 has $1250 max but the price is 10 more a week. Heavens I want the old plan! I know the max was higher since my crown was 1500. Last year dh had a few thousand in work done. Oh yep I hate change when it hurts my pocket book!
200 a month wow~! I was so hoping the ins stayed the same and we could pay our 2700 cash with a 10% discount. Now that our part will be 5000 I sure don't think it will be cash!!!

**nodmicks** · 07-20-2007, 08:12 AM

Originally Posted by dcompton

I thought my health insurance was confusing until I started trying to figure out the dental insurance! I more or less gave up and just let the dentist's office file and then pay them whatever the insurance doesn't. And it's stairstepped in confusing ways with even more confusing rollovers. I don't understand why it has to be so complicated. Sometimes I wonder if it's all smokescreen, but probably there is a legitimate reason for it.

I think your right about smoke and mirrors grumble!!!!. I actually understood the old plan.
Check up $5
Dental work we payed 20% before we left the office.
oral surgery copvered at 100%

**Telephus44** · 07-20-2007, 08:48 PM

Yeah, last time DH had major dental work I talked to the dentist's office several times, because our plan had a maximum benefit of $2000 per person per year. She said that it was very common for plans to have a cap - usually $1000 or $1500.

DH hadn't been to a dentist in 5 years, ended up having 4 wisdom teeth removed, plus an extra one that had rotted, gums scaled - we paid $4,000 out of pocket after the insurance.

You might also want to do the math on what is covered and how much it costs - I know that the first job I had dental was $5 a week for me (I was single) - so $260/yr - and my dentist only charged $70 for a cleaning. I have good teeth, so I just chose not to get dental insurance because it was cheaper for me to just pay the $70 myself twice a year. I'm not sure how many people you have, but you might want to look at this and run the math.

**DJ1972** · 07-21-2007, 02:08 AM

We just went through the orthodontics thing. DD13 and DS11 both have braces. I took out our dental insurance at work just long enough to get the $1000 per kid paid on the braces.....dropped the insurance after one year. It is only $75 for their regular dental check up/cleaning every 6 months, so it didn't pay to have the insurance any longer, but it was worth it to get the $1000 on the braces. Our orthodontist sets up payment plans at 0% interest with a $500 or higher down payment.

**nodmicks** · 07-21-2007, 09:50 AM

Originally Posted by Telephus44

Yeah, last time DH had major dental work I talked to the dentist's office several times, because our plan had a maximum benefit of $2000 per person per year. She said that it was very common for plans to have a cap - usually $1000 or $1500.

DH hadn't been to a dentist in 5 years, ended up having 4 wisdom teeth removed, plus an extra one that had rotted, gums scaled - we paid $4,000 out of pocket after the insurance.

You might also want to do the math on what is covered and how much it costs - I know that the first job I had dental was $5 a week for me (I was single) - so $260/yr - and my dentist only charged $70 for a cleaning. I have good teeth, so I just chose not to get dental insurance because it was cheaper for me to just pay the $70 myself twice a year. I'm not sure how many people you have, but you might want to look at this and run the math.

Oh wow 4000 is alot!!! The ins is 11 a week taken pretax. Our dentist charges 105 for a cleaning. There are 4 of us. I think it's likely worth the 11 a week since there are 4 of us getting cleanings 2 x a year. The kids get sealants and dh has terrible teeth. Plus the 1000 for the ortho.
I read the 2006 bills. INS paid out 3400 on dh alone. They paid 100% of oral surgery + dental work.

We were also offered eye ins and I took your advice and did the math. It was so not worth the $ to cover 4 of us when you added up the monthly cost, copays on yearly eye exams etc. However it was worth the 5 a month to cover only dh (the only 1 in glasses). Thanks for pointing out to do the math!!

**nodmicks** · 07-21-2007, 09:52 AM

Originally Posted by DJ1972

We just went through the orthodontics thing. DD13 and DS11 both have braces. I took out our dental insurance at work just long enough to get the $1000 per kid paid on the braces.....dropped the insurance after one year. It is only $75 for their regular dental check up/cleaning every 6 months, so it didn't pay to have the insurance any longer, but it was worth it to get the $1000 on the braces. Our orthodontist sets up payment plans at 0% interest with a $500 or higher down payment.

Sounds like you had a good plan!!! I wonder why some of you have such reasonable cleanings in your area. We sure don't (105).
I will definitely not complain about 1 child going into braces seeing you have two! Wow!