I need 4 cleanings a year, but struggling to find any provider covering more than 2.
I like my dentist, but he charges $180 per cleaning which seems steep.
I would be open to have those 2 extra cleaning done elsewhere though.
Any advice?
Comments
itsonlyastrongbuzz t1_j5u1wd1 wrote
Have you gotten a second opinion?
Changing your insurance before changing your dentist is kind of wild.
aleshere OP t1_j5u2e21 wrote
I am also trying to source a dentist that charges a decent price for a cleaning ($50-60).
I found recommendations for a few dental schools (BU, Tufts) but people say that it takes hours to get anything done.
I found a few cheap places (Gentle Dental for example) but they also seem to have bad reviews.
peteysweetusername t1_j5u6bsi wrote
Sorry to be blowing up your post but the reality is dental hygienists are getting $50 per hour. When you tack on overhead costs you’re not going to get a cleaning anywhere near what you’re expecting
joeyrog88 t1_j5vhibm wrote
But if you do two regular cleanings and two gentle dental cleanings... wouldn't you be okay? And also what about a legit electric toothbrush.
I was an asshole and my teeth were bad, two deep cleanings and they want follow ups but my hygienist is an absolute rockstar and hooked me up with a dope toothbrush. Either way a really nice toothbrush is way cheaper than $180.
zzzsleepygurll t1_j5u4aej wrote
I’ve always found gentle dental to provide a mediocre, but consistent cleaning. Very affordable too
StinkFloyyd t1_j5wdh0q wrote
In what universe is $50-60 for a 40 minute cleaning a decent price. The salary of the hygienist, plus rent, equipment and consumables, the cost of a dentist to supervise, liability insurance…suggest you go to a dental school
modernhomeowner t1_j5vxdzx wrote
I had a fantastic dentist when I lived in NY up until 4 years ago. $49 for a cleaning only, no exam, it was awesome, I would go every 4 months and get just one exam per year. Now in MA, the cheapest I could find for a cleaning was $125.
aleshere OP t1_j6fh0cq wrote
Yeah MA is the worst for these things
Large_Inspection_73 t1_j5ujo3r wrote
Try Tijuana. Lot of San Diego residents do that.
peteysweetusername t1_j5u61jj wrote
I get four per year and have had insurance with both delta and blue cross. Because I had scaling done a few years ago the 4x per year was covered. Not sure if that’s the case with you but I can find out more if that sounds familiar
makeupobsessedlawyer t1_j5v21eg wrote
Work in a dental office. After an SRP, scaling and root planing or also known as a deep cleaning, most patients are placed on a 3 month periodontal maintenance. That is seen as a different under insurance frequencies than a regular prophy which is only 2 times per year usually.
peteysweetusername t1_j5v7cyl wrote
This is the answer. His/her office probably doesn’t know how to code it
[deleted] t1_j5v8elv wrote
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peteysweetusername t1_j5valc5 wrote
Are you saying I have two insurances?
[deleted] t1_j5vd3l6 wrote
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Sardoniosophy t1_j5utfmb wrote
I have been with Delta, and they covered mine when I needed cleanings 4x a year. It came down to how the dental office coded the visits. As it was mandated by my dentist, I had no issues.
makeupobsessedlawyer t1_j5v2ji9 wrote
I work in a dental office. Has nothing to do with how offices “code” things. I’m so tired of patients thinking it’s the fault of the office because things get denied sometimes. The exact codes are billed on the date of service the services are rendered, there is no trick or sneaky thing offices do to get cleanings covered 4 times a year for patients. It has to do with your plan’s frequency limitations. Some plans allow 4 cleanings a year, like yours.
Sardoniosophy t1_j5v3eur wrote
While I don't work in a dental office and I know certain insurance plans have a limitation on how many of something or what is covered, I have also been explicitly told both by my service providers, i.e. the dental or doctor's office, and my insurance that applying the right/correct code makes a difference in coverage. I could be being gaslit by both sides, but I'm just sharing what my experience has been and what I have been told. 🤷♀️
yahabbibi t1_j5wmde2 wrote
The other commenter who works in dental billing is correct. There are frequency limitations on codes and a basic dental hygiene cleaning has only two codes for a basic prophy which is hand scaling and polishing: one code or adult patients (14 and up) and one for pediatric. A hygiene exam (w Dentist) is a separate code, fluoride is another. If your plan only covers 2 prophys per year (either 2x calendar yr or 2 6mo apart) and you're getting 4 for free your dental office is committing fraud by coding 2 of them as something else you have coverage for to get the insurance money. Root scaling? You'll need to look at your coverage and benefits and check the EOBs your carrier sends you after each service. If you only have 2 included in your plan and go 4 times for the dame service it should be coded exactly the same for all 4 visits. Fact.
aleshere OP t1_j5u6w05 wrote
I had that recommended but haven't done yet.
Will discuss with my dentist, it seems the best way forward hopefully he can help.
peteysweetusername t1_j5ui353 wrote
If you need scaling get it done asap. If your dentist is recommending it with cleanings 4x per year your gum recession is likely bad. A scaling will get the gunk that’s accumulating underneath the gum line and will improve your mouth hygiene. It will also qualify you for four free cleanings per year
makeupobsessedlawyer t1_j5v2poc wrote
Not necessarily true. Some plans only cover 2, the other 2 will need to be paid out of pocket. Doesn’t automatically qualify you. Check with your insurance and dental office.
peteysweetusername t1_j5v7lga wrote
As others have said on this post you don’t get “cleanings” after periodontal work you get perio maintenance which is covered every three months
[deleted] t1_j5v7see wrote
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candidcamerapeepshow t1_j5u2ati wrote
MassHealth can grant you 4 cleanings per a year if you file a an appeal with your dentist given that you have the necessary need for it.
Maxpowr9 t1_j5uoapz wrote
Good luck finding an adult dentist that takes MassHealth though.
MassHealth could be amazing if doctors are forced to accept it; having a certain % of your patients be on MassHealth for subsidies.
bostonchef72296 t1_j5vmoxk wrote
Windsor dental clinic through Cambridge health alliance takes masshealth. They’re great.
candidcamerapeepshow t1_j5uwpxa wrote
I see an academic dentist. Though she has me see the dental hygienist over the past few years
aleshere OP t1_j5u2oly wrote
This is interesting.
I am going next month for an out of pocket cleaning.
I will mention it to him and see if he can help?
Do you have experience yourself with this process?
candidcamerapeepshow t1_j5u2ymr wrote
My dentist advocated it for it because of my oral reconstructive surgery and dental implants.
Another scenario: I have a buddy who gets contacts covered because of his bulging eye and can’t wear traditional eye glasses.
Talk to your insurance, maybe
tandemtuna t1_j5u6pop wrote
Your dentist is ripping you off. I too need cleanings every 3 months, but my dentist bills the extra two at the same rate as she is reimbursed by insurance . Your dentist is charging you "list" price, the reimbursed rate is about half that.
aleshere OP t1_j5u9jea wrote
Next month will be my first time doing the out of pocket cleaning.
Will ask him if he can do what you're saying, thank you.
Autocorrectcaptcha t1_j5uhk6y wrote
Yes. Check if your insurance has clauses that say dentist has to bill you the insurance rate for services past your annual limits.
hotasspee t1_j5ue3bc wrote
if there’s a periodontal reason you need four cleanings per year (I’m assuming it has something to do with your gums) then your dentist should be able to make the argument that it’s preventive maintenance to the insurer and get the other two visits covered. if your dentist can’t or won’t do that it’s probably a sign that they’re not good patient advocates and you should find someone else.
no insurer will cover four cleanings a year unless your dentist fights for it, because private insurance is a Ponzi scheme that doesn’t work and needs to die.
mpjjpm t1_j5ujsbt wrote
Just be sure to check the extra cost of an insurance plane vs. the amortized costs of the cleanings over time. Four cleanings a year at $180 each works out to $60/month. Don’t pay more than that for insurance.
zootgirl t1_j5u291b wrote
I agree that you'll be hard pressed to find any dental insurer that will cover four cleanings a year. Maybe you could get the other two at either the Tufts or BU dental schools? I'm sure their wait-lists are long though and you must commit to a much longer appointment since they're teaching schools.
Chappy_Sinclair_ t1_j5u1q5y wrote
Dental schools maybe?
Gold-Air-49 t1_j5u45mh wrote
My BCBS plan covers 3 cleanings per year
RozenKristal t1_j5uue3d wrote
You are confused between prophy code and perio maintenance code. If you did a SRP and on 3 months recall for cleaning (perio maintenance code gonna be billed instead of prophy).
Basically routine 2 times per year covered is D1110. After the SRP, your 3 months service would be filed as D4910. Check your insurance on how they cover that code.
Running a dental clinic is extremely expensive, you wouldn't find places charging $50-$60 per cleaning anymore, even if you do, I would be very skeptical they doing good work...
> So what is the actual difference between prophylaxis and periodontal maintenance? The answer is simply determined by confirming what was actually done on behalf of the doctor’s diagnosis. Was it only scaling? Was it scaling and polishing? What and where was root planed? It is here that the actual definitions from Current Dental Terminology will be helpful.
>D1110 prophylaxis – adult Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.
>D4910 periodontal maintenance This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.
seh0872 t1_j5vf9f2 wrote
I go to the dentist four times a year. The trick was to be diagnosed with periodontal disease, which often requires a trip to the periodontist for scaling and planing. Then every other time is charged as a periodontal upkeep, alternating with semiannual cleanings.
AnyRound5042 t1_j5w4dct wrote
You can do it for free if you go to the students but it will take a lot longer
LadyGreyIcedTea t1_j5wb2a2 wrote
Dental insurance covering 2 cleanings/year is standard. Get a flexible spending account and you can pay for the extra cleanings from that.
Pencil-Sketches t1_j5wbl8i wrote
I don’t think most if any plans would cover more than 2 since ADA recommends every six months. Most plans would be up to $5k (more for couples or families) and 2 cleanings (some only cover 1 annual visit). If you have an HSA you could use that to pay for additional visits, but you could also check with Tufts Dental School. If you’re willing to be worked on by a dental student, you can get very cheap/free dental care
[deleted] t1_j5wk3h8 wrote
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Large_Inspection_73 t1_j5uqcya wrote
Dental insurance isn’t really insurance, it’s more of a discount card. You could try negotiating a cash discount with another dentist.
sprinklecattoo t1_j5u4kj2 wrote
Could you get on a spouse/significant others dental insurance? Maybe each would cover 2?
aleshere OP t1_j5u58fy wrote
I was reading that dual insurance coverage is not straight cumulative.
We might still have the 2 cleaning a year, but will double check.
husky5050 t1_j5uio9g wrote
You will still have two. The two plans coordinate benefits so the other plan tries to pay the amt not paid by the primary plan for the same service. It does not mean you have double the frequency of services.
Maxpowr9 t1_j5u181x wrote
I'd be shocked if you find any dental insurance that covers more than 2 cleanings per year unless you go the concierge route which would be a lot more than the price you listed.