Dentist / Insurance Experience and Recommendations

Submitted by Furlabun t3_10pcfgo in pittsburgh

UPDATE: Feb 6 2023.

Greetings yinz

I just want to put this here in care anyone needs it and is in a similair spot to me: no care credit, stuck with insurance, making too much to get sliding scale but living paycheck to oaycheck. You are worth the effort to live, and that means taking care of ur teeth.

I ended up going to Dr. Julia Dentice's practice at the rec of a friend. My dentist was Dr. Rumbaugh.

There's not a lot of info online but the whole practice is a hidden gem. They have their own in house payment plan. Together with my Cigna 5000/250 insurance I have a way forward that is in what i can do. The entire time I was treated like a real person and not a wallet and she was ready and willing to do everything on my teeth without even discussing money in depth. She answered all my questions, was patient with my anxiety and teeth in need of serious work. I'm two appointments in and I finally feel like I have a way out of the muck.

She encouraged me to keep my teeth and go for root canal rather than extract the worst of it, for my long term health. When I yold her the thousands I'd been quoted for several root canals at a "chain" dentist, she explained why that wasn't what i needed and that they could save my teeth. With the payment plan, and how kind the entire staff is... I really can't describe how I feel.

Please if you've been putting off dental and you can't get help on a sliding scale and are too anxious to go to the student clinic like me, and can pay but just need more time, patience, etc, please please please get to a dentist. You are worth that effort. I couldn't recommend Dr. Dentice's practice enough. I hope this or even the information others have posted here helps you.

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Hey y'all, giving a bit of context- thanks for reading-

I've been in the burgh for 2 years now- I have bad adhd and am suffering the toothy consequences despite trying to get my life in order, lol- So was finally able to get onto dental insurance- Cigna 5000/250- but I learned that on top of the 24 month waiting period, I can only get one major procedure done every 60 months. They don't really put that in your face until after you buy in, and I guess I didn't have enough insurance experience to even think that was a thing. I know I'll have some fillings, some root canals, which means crowns, or extractions and eventually either shelling out for implants or bridges or who knows.

Anyways. Looking for any answers/experience/dentist recommendations from anyone in my shoes- needing major dental work, has (bad?) insurance, possibly if you've used a discount plan. I'm not sure I have the guts to go to the Pitt dental school. I don't think Care Credit will take me, as I have a good credit score but was denied the pre-approval on a guesstimate.

I'm looking at potentially switching to Spirit Dental or the Cigna Dental Discount Savings Plus Plan, but I'm not getting clear answers from dentists when I try to call about if it's accepted. Spirit goes through Ameritas and when I called one dentist about the savings plan, the receptionist said "they might not take it, it just depends, it can be too cheap." And I just don't know if dropping money on something that might work but might not is worth it.

I've tried reaching out to sliding-scale clinics. Northside Christian isn't getting back to me and the one in Southside isn't taking new patients.

If you have any experience, in any of these plans or services or anything, I'd greatly appreciate your input. I am so afraid of dying to an infected tooth that I'm going crazy, haha. Thank you!

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EddieRyanDC t1_j6jp7vl wrote

In my experience, dental insurance is mostly a joke. What we need is insurance for major out-of-pocket expenses - root canals, tooth replacement, oral surgery. What it provides is checkups, an Xray, and discounts for cavities. Yeah, thanks - but I can mange those out of pocket.

All of that to say, look carefully and see if changing or waiting for insurance is worth it. You might just need to go ahead and do what you can afford today, and then more as you can save up.

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drfranff t1_j6jsw8m wrote

Yeah, came here to say this. Dental and eye insurance are both a bit scammy, in my experience.

OP, I'd start with finding a good dentist and getting their opinion on what is most important to do now vs what can wait a little bit. I don't think it's uncommon for dentists to offer lower prices for out-of-pocket payments rather than trying to go through insurance, and I do think a fair amount of places offer in-house payment plans. The insurance racket is kind of a nightmare for them, too, from my understanding.

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glitchgirl555 t1_j6js9pd wrote

Dentist chiming in here.

Do you have employer sponsored dental or are you paying the premiums yourself? If so then it usually doesn't make sense to even get dental insurance because all the terms and stipulations make it so you'll pay in more then you'll ever get out. It's different if an employer is paying a good chunk for you, then it often makes sense to get dental.

If you have plenty of time then the dental school is a great option. They are trying to enforce ideal dentistry so the quality is very high. The downside is each step gets checked plus the student is new at it so everything takes at least three times longer than at a regular office.

Dental insurance has been so bad recently that it can basically help you get one tooth fixed per year, especially if you need stuff like root canals and crowns. Cigna has actually been cutting reimbursement to dentists the past couple years. It's hard to make that work with inflation and higher staff wages and supply costs. For example we have patients with cigna where we only get $50 for a simple one surface filling. I can do one or two an hour so let's say $75 for the hour. By the time I pay my assistant and front desk and pay for the materials there is hardly anything left for my salary. So we are in the process of dropping cigna. I've heard from a number of colleagues who are also dropping them for the same reason. Some make it work by having a hygienist numb and an extended functions assistant place the filling so the dentist can see more patients per hour. Anyway I digress a bit...

Outside of going to the dental school you may want to find an office with an in office membership plan. There's usually an annual fee but then you get a percent off all treatment (we do 20%) that doesn't max out so you can get multiple teeth done and it won't stop giving you a discount. Then if you can't front everything you can see if the office has financing like care credit. Before you ask we aren't taking new patients, too busy.

Sorry it's a frustrating system. Not sure if it helps any but us dentists are frustrated too!

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PGHxplant t1_j6joooy wrote

I've been going to Dr. Christopher Hayner downtown for several years now and can't rave about him enough. I can't speak to Cigna specifically, but his office manager is an absolute rock star as well. One time I didn't even realize I had an issue with a claim until my next visit, when she casually explained how she'd un-screwed them without even having to bother me. She just knows all the companies and plans cold, and it wouldn't surprise me if she's got a direct-dial network as well. Well worth at least a phone call to discuss your circumstances.

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Furlabun OP t1_j6jqoi5 wrote

Thank you thank you- pretty intense before and afters- I will look into this and update with what I find relevant to my circumstances.

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KranchCruncher t1_j6jrajr wrote

If you an spare some upfront travel costs, highly recommend looking into going abroad to do dental work. I saved a fortune going to Costa Rica and had a GREAT experience.

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Jumpy-Natural4868 t1_j6joms6 wrote

pitt dental student clinic

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Furlabun OP t1_j6jpijy wrote

Thank you, but i mentioned that my anxiety after reading some reviews is preventing me from going and I'm not sure if I can get in quickly enough.

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CARLEtheCamry t1_j6jsq08 wrote

It sounds like you've covered all the bases I could think of.

Just went through a few years of major restorative work, with "good" insurance still capped at $2k/year payout and only covers 50% of the work. Financed on CareCredit (which you said you can't get approved for) defitenly helped smooth out the out of pocket side, and my dentist (Unis Dental in Hopewell) and his staff worked to come up with a multi-year plan to both maximize my insurance utilization, and prioritize the work that needed to be done (pain/need to have first, then appearance/nice to have).

One thing I can tell you - and I know you said the Pitt Dental School is probably out because of anxiety - but if they can help you out, it will have a huge impact on your overall mental health to not be self conscious about your smile/teeth. Maybe talk to whoever you're seeing, if they can give you an "emergency" pill to take the edge off.

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MisanthropicFriend t1_j6kbtmi wrote

I’ve went to nova dental in Bloomfield with state provided insurance, Cigna, and I’ve paid out of pocket. They’ve been pretty okay with payments n’at.

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[deleted] t1_j6l97si wrote

[deleted]

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Furlabun OP t1_j6ll2r1 wrote

Wow. I wish it wasn't so late or I'd call right now. Have you gotten dental work done here?

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Furlabun OP t1_j6mwq4w wrote

Following up on this I was unable to get an appointment. Apparently I make too much money, despite only being barely over the sliding scale requirement, and them saying they don't turn away people who are unable to pay is just a flat lie. Very disappointing. Thank you for the recommendation, I hope anyone else looking at this resource has better luck.

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__she__wolf t1_j6lsrog wrote

https://www.dentalplans.com/

I used this to find my “plan”. Saved me a ton of money.

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Furlabun OP t1_j6lto0z wrote

What dentist and what plan did you end up going with?

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__she__wolf t1_j6lu0mt wrote

I went with Aetna. Yearly fee of like, $170 and a lot is covered or at least partially covered. It really depends on what kind of work you need done. It may be worth for you or it may not. Check out the plans and see what’s right for you. You can choose between multiple.

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Formal_Development_4 t1_j6o2fhd wrote

Forget that insurance. Catholic charities has an affordable dental clinic. Mission of Mercy runs a huge weekend free clinic once a year in early fall. It even includes root canals. You might have to come up with a plan on what order to address your problems.

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