z31maniac
z31maniac MegaDork
1/21/25 7:38 p.m.

I have dental coverage through work for myself and my fiance. But it has a $2500 maximum (I need to double-check if that is total or per person). 

She is going to need at least one crown and a gum graft. It seems like there are situations where a gum graft may be covered under medical insurance (instead of dental) if it's deemed medically necessary (she has a couple of different auto-immune disorders). I also haven't done a great job of taking care of my teeth for years, so I'm sure I'm going to need to have some stuff done as well.

I've done some initial searching, but the way some things are worded, what is and isn't covered, if there is a waiting period (and sometimes it's only for certain procedures), etc. 

Are there brokers for things like this? Like how there are brokers for homeowners, auto, etc?

Ranger50
Ranger50 MegaDork
1/21/25 9:26 p.m.

There is always CareCredit available for more than what your coverage allows.

docwyte
docwyte UltimaDork
1/22/25 9:45 a.m.

Don't bother.  Also if you've got $2500/year/person coverage that's actually very good coverage.  I'd be shocked if the graft was covered under medical insurance.  Even if it is, I'd be even more blown away if the dental office did all the claims paperwork and then agreed to accept the medical fee for it.

Dental insurance isn't insurance, it's a defined benefit plan.  They'll pay a certain percentage of procedures, up to a set maximum a year.  You're better off setting up a health savings account (HSA) that you use with all your providers, that way you use pre tax dollars.

Katya4me
Katya4me Reader
1/22/25 9:59 a.m.

I had a gum graft in 2022, not fun.  They took my insurance information, but I was required to cover the cost upfront and if insurance came through, I'd be reimbursed.  Fortunately, mine did end up reimbursing, about 75% but I went in with the understanding that it might be 0.  Also, be sure to look into how they do the graft and what your options are. 

z31maniac
z31maniac MegaDork
1/22/25 1:13 p.m.
docwyte said:

Don't bother.  Also if you've got $2500/year/person coverage that's actually very good coverage.  I'd be shocked if the graft was covered under medical insurance.  Even if it is, I'd be even more blown away if the dental office did all the claims paperwork and then agreed to accept the medical fee for it.

Dental insurance isn't insurance, it's a defined benefit plan.  They'll pay a certain percentage of procedures, up to a set maximum a year.  You're better off setting up a health savings account (HSA) that you use with all your providers, that way you use pre tax dollars.

Good to know. And I always have used the HSA plan when it's available.........currently have an HSA plan now. 

jwagner (Forum Supporter)
jwagner (Forum Supporter) HalfDork
1/22/25 7:58 p.m.

I think @docwhyte is right on this.  I do have an insurance broker for medicare supplement insurance, dental, drug coverage.  Calls himself a "benefits specialist" and seems to find decent plans.  My plan sounds about the same as yours, as did my company provided plan a couple of years ago.  Mostly useful for bi-yearly cleanings and negotiated rates on everything else.

Slightly on topic...  I had a crown put on with dental coverage about a month ago.  Cost me about $650 out of pocket and I think insurance covered half.  Started hurting about a week ago and went into holy crap that hurts mode just in time for the weekend.  Finally saw a dentist this morning.  Got X rays, exam, and a couple of scripts to get ready for the root canal.  No insurance:  $35.  Scripts will be under ten bucks.  (Portugal.)  Root canal will be about $250.  First time at a dentist here.  I'm impressed and relieved.

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