10 replies to this topic

[Lexington Hills]

First post...so hello!

Its open enrollment time again at work and I'm wanting to switch my dental insurance to deltacare DMO instead of the delta dental ppo I have right now.

My understanding is the DMO should have lower procedural payments? I need a root canal redone and am thinking they will have to do a new crown. Last time I had this done it was about $800 because of the special ceramic/composite crown they sold me on. I'm hoping not to repeat having to pay that much again, hence deltacare DMO.

I have a couple of choices:
Smilecare. I've read a bunch of bad things about them on the forum. They are out of the question.
Gateway dental. They sound like car dealers to me. Always wanting to upsell something or do some other procedure to make your smile "better." They also seem to have long waits.
Cosmetic Dental Studios I havent heard anything about them. I think they are located in the California family fitness area.
Green Valley Dental Not too much info on these guys, but what I found looks promising.

Any help choosing one of these would be great!

Thanks in Advance!

[justme]

First post...so hello!

Its open enrollment time again at work and I'm wanting to switch my dental insurance to deltacare DMO instead of the delta dental ppo I have right now.

My understanding is the DMO should have lower procedural payments? I need a root canal redone and am thinking they will have to do a new crown. Last time I had this done it was about $800 because of the special ceramic/composite crown they sold me on. I'm hoping not to repeat having to pay that much again, hence deltacare DMO.

I have a couple of choices:
Smilecare. I've read a bunch of bad things about them on the forum. They are out of the question.
Gateway dental. They sound like car dealers to me. Always wanting to upsell something or do some other procedure to make your smile "better." They also seem to have long waits.
Cosmetic Dental Studios I havent heard anything about them. I think they are located in the California family fitness area.
Green Valley Dental Not too much info on these guys, but what I found looks promising.

Any help choosing one of these would be great!

Thanks in Advance!

Worked in a dental office. I know the deltcare DMO signifcantly will reduce your out of pocket epenses, but please make sure you fully read and understand the plan. It is your responsibilty to know what your plan affords you, if you need questions answering go to your HR department, as it was your emoloyer who negotiated with the insurance company how much they want to pay, for benefits, frequency of prevenative visits, emergency visits, dental materials used for restorative work, maximum $ amount per benefit year etc.

Also when looking for a dentist never ask do you take ABC dental insurance, they will always say yes, re phrase and ask are you a in network provider for ABC dental insurance and give them the plan name PPO/DPO/DMO etc.

If you have dual coverage always check on your plan, do they go hand in hand (any $ amount primary does not pay the the secondary will pay, therefore no out of pocket for you, unless you max out of your $ amounts), or does the secondary only kick in once the primary's maximum $ amount has been used.

Good luck

[bv1016]

Worked in a dental office. I know the deltcare DMO signifcantly will reduce your out of pocket epenses, but please make sure you fully read and understand the plan. It is your responsibilty to know what your plan affords you, if you need questions answering go to your HR department, as it was your emoloyer who negotiated with the insurance company how much they want to pay, for benefits, frequency of prevenative visits, emergency visits, dental materials used for restorative work, maximum $ amount per benefit year etc.

Also when looking for a dentist never ask do you take ABC dental insurance, they will always say yes, re phrase and ask are you a in network provider for ABC dental insurance and give them the plan name PPO/DPO/DMO etc.

If you have dual coverage always check on your plan, do they go hand in hand (any $ amount primary does not pay the the secondary will pay, therefore no out of pocket for you, unless you max out of your $ amounts), or does the secondary only kick in once the primary's maximum $ amount has been used.

Good luck

I work at Delta and the above post is right on, it will only benefit you if you see specific doctors, and sometimes the ones that are in network are fewer. The reason it is cheaper is because the doctors that "network providers" for this program, have agreed to accept a lower fee for services.

Also, regarding dual coverage... tha magic words are "coordination of benefits" ask your secondary coverage if they coordinate benefits, if they say yes... you're good. If they so no, chances are you'll be paying money out of pocket.

[devnull]

I have just had a bad experience with Green Valley Dental Group....

My wife and I both needed a cleaning....we got an appointment for the same day...

It took her three hours for them to get Xrays and perform the cleaning which I thought was ridiculous....she was waiting a very long time.

For me they said I needed a "special" cleaning that my insurance (Aetna PPO) would not cover (it covers most things at 90%) at a cost of $375. I walked out...we will be taking our family elsewhere from now on.

[asbestoshills]

Scary....DOn't get an HMO dental...They are the worst! Pay cash instead and save your monthly allotement for a regular ppo plan...

[sactown64]

I recently had to goto a dentist, I had a filling that broke and I was in pain. So I looked up the closest dentist to me that took my coverage and found Gateway Dental. When I got there they were very nice during the whole process. But when I kept asking what my insurance covered, I could not get a straight answer... After they were done drilling away the bad parts, hardly any tooth left. The dentist then gave me the prices on crowns (again still in pain), which ranged from $500 metal/porcelain, $650 gold/porcelain and $1100 full porcelain (stupid me took his word). I didn’t want any metal crowns (FYI: metal isn’t good for your gums or teeth unless it’s gold), so my only choice was a full Porcelain crown at $1100 (or so the dentist told me). When I was still undecided because of the cost, he suggested a Partial Crown called an overlay to save me money - $750 my cost over what my insurance covered (again what the dentist told me)... So I went with the overlay to save me money. The receptionist came in and went over ONLY the cost of the work would be. She quickly had me initial for the COST of the work ONLY she said before they got started. So I did and they did the work. Now, when I took a look at the receipt when I got home, I saw a basic coverage under what I paid, which showed a metal/porcelain $50 not $500(which was the price given) and no coverage for an overlay. So I called the insurance company and found out that ALL the crowns were covered for $50+$150 upgrade for a molar ($200 total). When I called the office to try and get an answer as to why they MIGHT not have told me the truth about the costs, they told me the overlay was better than the other crowns and it was too late I already signed for the work, sorry. I asked why would I pay $550 extra per tooth... they wouldn't tell me and said it was my fault for not knowing. So if you decide to go there KNOW what exactly is covered (including Procedure codes) or they will take advantage...

[Lauren]

I recently had to goto a dentist, I had a filling that broke and I was in pain. So I looked up the closest dentist to me that took my coverage and found Gateway Dental. When I got there they were very nice during the whole process. But when I kept asking what my insurance covered, I could not get a straight answer... After they were done drilling away the bad parts, hardly any tooth left. The dentist then gave me the prices on crowns (again still in pain), which ranged from $500 metal/porcelain, $650 gold/porcelain and $1100 full porcelain (stupid me took his word). I didn’t want any metal crowns (FYI: metal isn’t good for your gums or teeth unless it’s gold), so my only choice was a full Porcelain crown at $1100 (or so the dentist told me). When I was still undecided because of the cost, he suggested a Partial Crown called an overlay to save me money - $750 my cost over what my insurance covered (again what the dentist told me)... So I went with the overlay to save me money. The receptionist came in and went over ONLY the cost of the work would be. She quickly had me initial for the COST of the work ONLY she said before they got started. So I did and they did the work. Now, when I took a look at the receipt when I got home, I saw a basic coverage under what I paid, which showed a metal/porcelain $50 not $500(which was the price given) and no coverage for an overlay. So I called the insurance company and found out that ALL the crowns were covered for $50+$150 upgrade for a molar ($200 total). When I called the office to try and get an answer as to why they MIGHT not have told me the truth about the costs, they told me the overlay was better than the other crowns and it was too late I already signed for the work, sorry. I asked why would I pay $550 extra per tooth... they wouldn't tell me and said it was my fault for not knowing. So if you decide to go there KNOW what exactly is covered (including Procedure codes) or they will take advantage...

Future reference to anyone!!!!
It's is VERY VERY VERY rare to have dental coverage for an Onlay, Overlay, or Inlay... those just aren't covered by dental insurance companies!!!!!
Sorry to hear that you had to find out the hard way and that they weren't more informative when it came to that stuff. How frustrating!!!

[Sam Powers]

upgrade for a molar ($200 total). When I called the office to try and get an answer as to why they MIGHT not have told me the truth about the costs, they told me the overlay was better than the other crowns and it was too late I already signed for the work, sorry. I asked why would I pay $550 extra per tooth... they wouldn't tell me and said it was my fault for not knowing. So if you decide to go there KNOW what exactly is covered (including Procedure codes) or they will take advantage...

my 2 cents - onlays r better than cr's; You only replace the part of the tooth that's missing or defective + there in NO metal at all. But to each their own.

[Sam Powers]

For me they said I needed a "special" cleaning that my insurance (Aetna PPO) would not cover (it covers most things at 90%) at a cost of $375. I walked out...we will be taking our family elsewhere from now on.

so it's green valley's fault that you have gingivitis; ofcourse you would never blame them few years later when your gingivits gets worse or you loose some teeth because they did the REGULAR cleaning...ugh.

[FolsomKevin]

I had a remarkably similar experience with Gateway Dental as sactown. I don't know what that other poster meant about insurance not covering onlays and crowns. There are lots of insurance plans, and mine definately covers these things. However, Gateway Dental told me that my insurance did not cover it! Afterwards, I got suspicious and checked, and the insurance company assured me that this was covered, so I confronted them at Gateway. I showed them the coverage booklet and the email I received from my insurance, and they continued to insist that it was not covered.

I had to file a grievance with the insurance company, which ruled in my favor and directed Gateway to issue me a refund of over $1000. Gateway refused! They said the insurance company was wrong and that they wouldn't issue the refund.

It was a lengthy ordeal, over 3 months, and in the end, Gateway continued to refuse to issue the refund, so the insurance company sent me a check and deducted it from their other payments to Gateway. Why they refused to follow the very plainly worded coverage, complete with matching billing codes, was never explained.

Before I realized how crooked they are, I had taken my wife to the office also. At that time, I was still convinced that it was simply a billing mixup. I left her there to have some work done, came back an hour later, and found that nothing had been done. Gateway now required me to pay in full, in advance of treatment. Evidently they were worried that I wouldn't pay, since they owed me over $1000. I asked them, "Don't you trust me?" (They have always collected payment after the work is done in the past). Their excuse was that the office staff was leaving for the day, which was a full-on lie, because I stayed in the office after I paid, and no one left.

Something is very wrong at Gateway Dental. I will never use them again for anything.

[tammya]

Hi Lexington Hills,

Wondering if you made a decision and who you chose. I am in the same situation at the moment and my choices are the same ones you were inquiring about. I had the worst experience today with a dentist I chose in Placerville and I am now looking for someone else. Please if you were happy with your choice I would love to hear about it or if anyone has anything GOOD to say about the dentists you listed.

Thanks