ah, modern medicine.

eek i don’t have dental with Blue Shield, but i do have medical… have only been with them since late last year. has anyone had any problems with their medical coverage? :O

I gave up on dental programs over a year ago. I was likewise frustrated and spent hours looking and calling. So I picked the dentist I wanted and paid out of pocket. Great dentist, great service and everyone’s happy—pure capitalism at work. And, the out-of-pocket expense isn’t all that much more than what I would end up paying anyway. I think that the better dentists don’t even take insurance. Good luck!

check with your insurance….my dentist makes me pay first and files the claim on my behalf…because the insurance company must pay me within 30 days by law. Like you said…the dentist would have to wait for his money.

I had a most disheartening experience with the dentist on Berryessa in San Jose, CA.

First she prodded me to go for the more expensive procedures and insisted I can claim part of it from insurance.

In an act that borders on fraud, she didn’t show me the actual cost, only the estimated amount that I have to pay out- of-pocket for the procedures ($600). Which I paid.

But later she sends me another bill for $300 (!!) because “the insurance didn’t cover that much after all”.

That’s not all. In addition to those, I signed up for her cheaper version of “Britesmile” teeth whitening. She enthusiastically “guaranteed” me I could go at least 4-8 shades whiter.

The end result was, $400, for only 2 shades whiter. She then denied ever making such an “unprofessional claim. I never would have said that!” (her words)

She then had the FREAKIN nerve to say, ” You know, you Asians have teeth that unfortunately do not respond the treatment as well.”

!!!!!!!!

HI Eric: I found your post because I recently started a blog on health care issues, from a layman’s perspective. My blog advertiser is eHealthInsurance.com, so I asked them how they would respond to your complaint above, and they sent me a rather lengthy reply…which I posted on my blog:
http://www.healthyconcerns.com.....ntal_.html

If I were you I’d drop your dental through Blue Shield and get an individual plan through Dellta Dental. I think most dentists take Delta, and it probably costs no more than what you’re paying now via BlueShield.

Elisa – thank you for your research! I ended switching to Blue Shield PPO, who then waived the 1 year waiting period for serious dental work because I was coming from another Blue Shield plan.

I’ll check out Delta Dental; I’ve heard good things about them.

Eric:

You hit a very good point. Most dental HMO plans are faced with the same problems that have been described here. The situation of a dental provider trying to sell you more expensive proceudres is called the “upsell”. This is an attempt by the dental provider to get you to agree to a more expensive procedure they know the insurance company will not cover so that you have to pay full price for it.

As with medical, the dental HMO works off a “capitated” method of payment in which your chosen dental provider is paid a flat amount every month whether you go for treatment or not. On top of that, your dental HMO (DHMO) has procedural copayments which also supplement this capitation. Finally, on top of this, different insurance companies will also offer additional payments which are usually referred to as “safety nets” which make payment guarantees based on patients, chair hours, etc.

Admittedly, the compensation is probably not what most providers would like to see, but remember that HMO dental plans are geared (much like medical HMO) towards prevention. If you have a need for comprehensive dental work, the Dental PPO (DPPO) is always going to be the better plan. HMOs, whether medical or dental are a good, steady source of revenue for new providers who are building their practices. Once a provider has “established” his / her practice, they may see no further benefit of contracting with any HMOs regardless of medical or dental.

With regards to your waiting time imposed for major work, that is not common of DHMO plans. DHMOs typically have no waiting period for major work, no deductibles, no annual maximums. Most DPPO plans will impose a 12 month wait for major work (Blue Shield’s DPPO plans, I know do not unless you are on a Voluntary plan).

Delta Dental is a very good carrier, as Elisa pointed out and is very well known due to strong brand name recognition. But I can guarantee you that they have the same issues with their DHMO. Because they are as big as they are, they are able to throw more money at an issue than a smaller not for pofit company like Blue Shield, so you may not hear of some issues as much.

Regardless of which dental plan you choose, keep the following in mind…

1) Every insruance company makes claims of having very large provider networks. The initial credentialling process does allow a company to investigate the practice of any newly applying provider. However, there is no insurance company out there with the manpower to go back and revisit every provider’s office as much as we’d all like them to. the best way for the carriers to be aware of the issues is to call the customer service numbers and report the problems. If providers are repeatedly getting complaints, their procatices will be reviewed.

2) Every insurance company will say almost anything to gain your business. It boils down to who delivers what they promise. Remember, if one stands out as making promises no one else does, then they may not be giving it to you stright.

3) Don’t be afraid to consult an insurance broker. A lot are knowledgeable about the insurance market and your options. An no, using them will not cost you any additional money. Their commissions will be part of your rate. (For all of you out there reading this who are individuals taking care of their own policies without an insurance broker, you may not saving money as most plans have the broker commissions built into the rate)

Good luck!

Bill,

You are mistaken in your explanation of the upsell. You should realize that dentists are not like car or tv salesmen. When they recommend a more expensive treatment (with, admitteddly the exception of tooth bleaching which is a purely cosmetic procedure) it is because that treatment IS more beneficial to the patient. For example, a crown is better than a large filling b/c the filling WILL absolutely break over time and cause more problems than the more expensive crown. Also, when a more expensive treatment is selected by the patient, it doesnt affect the provider’s bottom line. Because the provider sets their fees independadtly (most dentists 80% are not, the others are intracted with that insurance, in which case dont go to them b/c that means they cant get patients without it). That means the dentist will get their money either way, whether you or the insurance pays for it. You are assuming that the dentist would not require full payment from teh patient upfront and let the patient be reimbursed by insurance, but that is the best business practice and is the fairest method for both patient and dentist.

-Edgar

Does anyone have a list of health plans that I could lobby my employer to use, that does NOT use capitation?

thanks!

Just go with a dental plan and not an insurance plan. The saving can be close to the same and most places take them. The cost is only around 80 bucks a year for just one person and many places will aprove you within 3 days.

Wanna hear some horror stories about their Health Plan? I have Blue Shield with Medicare. Blue Shield is the only provider I can have in the County I live in, monopoly? The doctors they demand you see are horrible. I recently changed from a dr that would not let me see a specialist for herniated disks, he told me I am not a candidate for surgery, meanwhile some of my friend were having surgery for the same ailment! I changed doctors, there is a 5 week wait to see the (new)dr. so I saw the Nurse Practitioner and she wanted to change my medications without even seeing my medical records! I have some very serious health problems and to start making changes in meds could really cause some damage, they don’t care, life is cheap in this county. Then she said she would send a Rx to my pharmacy. It was never sent, I phone the office, no reply so I wrote a letter asking why. My old doctor did this too; if I needed nitro glycerine I would be dead by now because they can’t get a simple Rx to the pharmacy without skrewing it up. I am going to document everything because I suspect a law suit somewhere down the line!

I just got off the phone with a dentist I wanted to take my 12 year old son who has Autism and has MAJOR fear of the dentist. I called Blue shield dental hmo since the assigned dentist did not call me back for the referral. I was pleasantly surprised when I was trasnfered to a person who could help me. Shirley called the peditrics dentist, gave her the authorization and called me back. we will be seeing the peditrics dentist tomorrow, yes on Saturday for her to attend to my son’s painful tooth. I just wanted to share that sometimes we reach the right person who goes out of their way to help and take care of the problem. Thank you

Nice and quite informative blog. As a student of finance this post will really help me a great deal. Keep posting the good work.

rocklin dentist

Yeah .. I also think that it's crap … nice !

Excellent! Great article, I already saved it to my favourite,

This is the great blog, I’m reading them for a while, thanks for the new posts!

I am also disgusted with the selection on blue shields hmo dental plan. I’ve decided to stop my dental coverage with blue shield & also see my wife’s previous ppo dentist for out of pocket charges for both of us. This crap is just a piece of what’s wrong with the so call system!!!

the plan is cheaper to buy. nobody wins (except the insurance company)- the dentist doesnt really get paid and the patient will need to pay out of pocket for sure. HMO- health maintenace org. = preventative only, not for restorative. you pay less for your insurance and when something arises, you pay directly.

i have blue shield as well. i know their service sucks but keep trying. go to find the list of physicians/providers plug in your zip. there were two dentists who were avaialable for a cleaning within a couple of weeks for me where i live.

um I think you are mistaken. The PPO has a wait period. The HMO does NOT!

i was searching for a blue shield hmo dentist in redlands, ca when i stumbled upon this website. i just want to say thank you for venting and allowing the rest of us to also say how stupid blue shield hmo is when it comes to issues like these.