Met life, safeguard premier choice Safeguard premier choice dental and vision hmo The same as another complaint, I am on my secound dentist after being told what safeguard pays for numerous crowns, and only to be told by the dentist they cannot do the procedure for that.. For insta Aliso viejo, California

-->  HMO type insurances are horrible for patients.

I am assuming that since this is an HMO, that you have purchased an insurance plan on your own, not through an employer? And probably because you either knew that you were going to need expensive dental work, or were suspecting that you would?

What irritates me is that out of 6 years of dentistry, I have never been a witness to a patient only needing to pay $245 out of pocket...$325 is the MINIMUM that I have seen being out of pocket for a patient, and that has happened 1 time.  Many, not all, insurance representatives will twist and distort the truth.

Some ideas for insurances:

-When searching for an insurance you want to have a PPO plan as your primary insurance, and use a supplemental plan such as Aflac or what ever, as your secondary. Many dental providers will not file Aflac for you, or will charge a fee to file this.

-Make sure to check for 6-12 month waiting periods for major dental services (d2740-d2752).

-Make sure that when they tell you that the insurance will pay for 80% of every basic filling, that they clarify if there are frequency limitations, like, they will only cover on (1) single surface filling every 12 months, and so forth.

-Also, if periodontal disease is present (neccessitating deep cleanings or gum therapy or scaling/root planing) make sure that the company will cover a percentage on more than 1 quadrant of the mouth every 12 months. Why? Because you have 4 quadrants in mouth.

-Check replacement frequencies for replacement crowns, replacement partials or dentures. Many are 60 months for initial placement of prosthesis, however I had encountered a 10-year replacement.

How PPO's work: When a dental provider partners with a PPO insurance plan, they have agreed and signed a contract with that insurance company to provide a service to a patient for a certain price. So, you are getting a 10%-50% discount on a service to begin with, and then you would only pay a certain percentage + a deductible.

Ex:

Your bottom left molar requires a crown because a large portion of the tooth has broke or has had a root canal treatment. Your dentist is recommending that you have a crown to secure the tooth and you want to.

Fee for service (No insurance)

d2740 (porc/ceramic crown)      $    1295                You pay that!

With PPO insurance plan        

d2740 (porc/ceramic crown)       $    704.00

Insurance covers 40%                -   $281.60   

Applied deductible                         + $50                 You might pay...$472.40

Make sure your dentist has his dental assistant take pre-operative xrays of the tooth on date of service. If correct xrays are not submitted, insurance will not cover their part, and you will be responsible for the remainder. Even though it's their responsibility.

Check the reduced fees before committing to an insurance. It's more logical to get an insurance that reduces the fees 40% that is an 100/80/60 plan (the covered percentages) that to get an insurance that reduces the fees 20% but covers a $1000 crown at 80%. Why? Because you will be at your yearly maximum with only 1 procedure, and not have enough insurance left over for routine cleanings.

I hope this helps you some....if you are giving up on insurance and frustrated, discount dental plans are great, like Vantage One. But there are others.

-A Caring Dental Professional

How many crowns are you talking about? My last one was $1150 - Insurance covered 50% and Aflac covered 25%. How long have you had this insurance?