Negotiating with Orthodontist

[DreamIsaWish]

So, we screwed up and got my son braces at an orthodontist that's not in network. (Yes, I know it's stupid but I really don't feel like rehashing the details.) The braces are already on so I'm thinking we're stuck at this orthodontist.

Any ideas on how we might negotiate on fees? They already offer a 5% discount for upfront payment instead of installements. But I'm thinking if we had gone in network there would have been negotiated fees in addition to a better coverage %age. I'm wondering if we'd have any luck in trying to get closer to insurance negotiated fees (and how we might figure out what that number might be).

Any thoughts on either numbers or negotiation approaches (what to say, etc.) would be appreciated. Feeling really stupid right now and trying to make the best of it.

 

[happily single]

I was going to suggest asking for a cash discount if paid up front. BUT since the braces are already on I highly doubt they will work with you anymore than what they already offered.

 

[Marionnette]

So, we screwed up and got my son braces at an orthodontist that's not in network. (Yes, I know it's stupid but I really don't feel like rehashing the details.) The braces are already on so I'm thinking we're stuck at this orthodontist.

Any ideas on how we might negotiate on fees? They already offer a 5% discount for upfront payment instead of installements. But I'm thinking if we had gone in network there would have been negotiated fees in addition to a better coverage %age. I'm wondering if we'd have any luck in trying to get closer to insurance negotiated fees (and how we might figure out what that number might be).

Any thoughts on either numbers or negotiation approaches (what to say, etc.) would be appreciated. Feeling really stupid right now and trying to make the best of it.

The problem for you is that this orthodontist is NOT in-network. He probably isn't in-network because he doesn't care for the reimbursement that your insurance provides. Trying to negotiate from that stance is not going to work now. It might have worked prior to having the braces done, based on the theory that half of a loaf is better than none. Once you signed the paperwork and had the work done, you agreed to pay his rate.

At this point, you would be better off trying to negotiate the discount for paying in full. 5% is not very generous. If you offered to pay by check or cash (as opposed to credit card), you may have some leverage because it will save him the merchant fee (which is around 1.5%-4%, depending on the cards he accepts, the volume that he does and the company that he uses to process his charges).

You should also check to see if your insurance provides anything for using an out-of-network provider. It depends on the insurance company and the plan, but some will give you an allowance of $XXXX toward the cost. The problem with those claims is that you have to pay OOP first and then apply for reimbursement.

 

[DreamIsaWish]

I know I'm grasping at straws here. My husband decided on this orthodontist right at the initial consultation and had the work done. To say I was not pleased is an understatement. I assumed we would shop around and get a second opinion or at the very least that this was an in-network provider.

I also thought that the 5% prepay discount wasn't particularly generous so I have sent my husband to negotiate a better cash discount (he hates negotiating so we'll see how that works out). We will get something from insurance but of course it's not as much as in-network. The remainder we'll pay through the Health Savings Account (HSA) but I didn't put enough in there for this new higher expense. Part of me wants to shop around and see if we can switch even now (after all, kids move houses and have to switch orthodontists in the middle) but the other part of me says that might not work out too well and also might subject my son to extra stress/trouble.

Any ideas as I grasp at straws are appreciated.

 

[ajwolfe]

Sorry to say, but I think you are stuck. One of my boys just got braces and we negotiated the rate and signed the contract before any work was done. IMO that would have been the time to negotiate before you signed the contract.

 

[SharonZ]

I wouldn't suggest switching orthodontists at this point, since you aren't disappointed in the work, just the price - which was in the contract that you signed. It would be like purchasing a car, then bringing it back and stating that you were charged too much and want to negotiate a better price. Chances are if he is out of network, the 5% is all he will allow as a discount. All cash may get you something extra, but at this point I doubt it. But, good luck!

 

[DreamIsaWish]

I wouldn't suggest switching orthodontists at this point, since you aren't disappointed in the work, just the price - which was in the contract that you signed. It would be like purchasing a car, then bringing it back and stating that you were charged too much and want to negotiate a better price. Chances are if he is out of network, the 5% is all he will allow as a discount. All cash may get you something extra, but at this point I doubt it. But, good luck!

Actually my husband signed the contract without checking with me (and the insurance is my plan), but your point is well taken. I think I'm mostly angry at him and need to get this off my chest. And asking for advice at least feels more productive than yelling at him.

 

[gwynne]

Actually my husband signed the contract without checking with me (and the insurance is my plan), but your point is well taken. I think I'm mostly angry at him and need to get this off my chest. And asking for advice at least feels more productive than yelling at him.

The contract is signed. You will want to have a nice, positive relationship with this office. I don't really see any upside in attempting a negotiation after signing. It would just make you "that parent" and they'd still say no.
Frustration is understandable, of course. I hope you feel better after talking about it here.

 

[SEA333]

The contract is signed. You will want to have a nice, positive relationship with this office. I don't really see any upside in attempting a negotiation after signing. It would just make you "that parent" and they'd still say no.
Frustration is understandable, of course. I hope you feel better after talking about it here.

I don't see anything wrong with explaining the situation and asking in a polite and respectful way if their is any other discounts that the OP can take advantage of. After all, how many times have I gotten ads in the mail for $300 off, or free x-rays, or free consultation with a % off if we signed that day, etc? There is definitely room for negotiation, and even MORE room if OP has younger children that will one day need braces.

OP - I would simply explain what happened, and say that you guys loved the office from the first apt and want to see if there is something you can work out. Absolutely NO harm in trying. You will *not* be "that parent".

 

[mjkacmom]

Our orthodontist does not negotiate. I've paid them $13,000. For the first two, and just starting on the third. Dd13 has been going twice a year for years, has had several X-rays, and now it appears she doesn't need braces. I never paid anything for her. Our insurance pays $1500 max for each child.

It would be complicated to switch for us. Everything is included in the price - heck, dd18 still goes twice a year to make sure things aren't shifting.

 

[KKB]

Our orthodontist does not negotiate. I've paid them $13,000. For the first two, and just starting on the third. Dd13 has been going twice a year for years, has had several X-rays, and now it appears she doesn't need braces. I never paid anything for her. Our insurance pays $1500 max for each child.

It would be complicated to switch for us. Everything is included in the price - heck, dd18 still goes twice a year to make sure things aren't shifting.

Our daughter had very extensive work done & it was $4K OOP--our insurance pays 50%.

 

[MUN]

So, we screwed up and got my son braces at an orthodontist that's not in network. (Yes, I know it's stupid but I really don't feel like rehashing the details.) The braces are already on so I'm thinking we're stuck at this orthodontist.

Any ideas on how we might negotiate on fees? They already offer a 5% discount for upfront payment instead of installements. But I'm thinking if we had gone in network there would have been negotiated fees in addition to a better coverage %age. I'm wondering if we'd have any luck in trying to get closer to insurance negotiated fees (and how we might figure out what that number might be).

Any thoughts on either numbers or negotiation approaches (what to say, etc.) would be appreciated. Feeling really stupid right now and trying to make the best of it.

I think your stuck. The time to negotiate a rate is b/4 you sign the contract. Live and learn.

MUN

 

[DreamIsaWish]

Our daughter had very extensive work done & it was $4K OOP--our insurance pays 50%.

I don't know whether to be encouraged or discouraged by this. Right now they're quoting about $4K total, of which 75% is OOP. So, that's better than $4K OOP at 50%. But, we're only at "phase 1" and could need more work later as his teeth continue to come in.

 

[supersnoop]

What does your insurance actually cover? Most dental insurance covers very little, and doesn't mandate that providers accept a negotiated rate. I don't know that in-network would actually be cheaper.

Unless you have a DMO plan, in which case you have to get approval and prove that braces are required for non-cosmetic reasons.

Basically, your dental insurance will still pay out the same amount, and it's unlikely that another dentist would offer a much better price.

 

[MichiganKris]

My insurance paid the same in or out of network. $1500 maximum per person. We were charged $5000, so out of pocket was $3500.

 

[yoopermom]

I remember thinking as I signed the ortho contract that it was like signing my life away, so I'm sure you're stuck with it, since your DH signed it.

Ours just happened to work out where we had one insurance when we started with the ortho (which covered $1500 as other PPs have said), and then partway through it I got a job with new/better insurance, which paid another $1500, but even so we still paid at least 2K out of pocket.

I don't totally blame the ortho, because they need to know that you're in it for the long haul, financially, since they are for the treatment.

Terri

 

[PlutoPony]

I don't know whether to be encouraged or discouraged by this. Right now they're quoting about $4K total, of which 75% is OOP. So, that's better than $4K OOP at 50%. But, we're only at "phase 1" and could need more work later as his teeth continue to come in.

Does your current contract only cover Phase 1? If so, you'll essentially get a do over if Phase 2 is required. Should be easy to get 2nd opinions at that point and then you can ask current ortho for a better price or you leave. Just make sure your other options aren't going to be more expensive should they want to take a different approach than is currently being taken

 

[cvjw]

I don't know whether to be encouraged or discouraged by this. Right now they're quoting about $4K total, of which 75% is OOP. So, that's better than $4K OOP at 50%. But, we're only at "phase 1" and could need more work later as his teeth continue to come in.

What is included in Phase 1? Both of my boys had Phase 1 and then Phase 2 a few years later. Phase one included a few braces on the front teeth and then a device to stretch out the pallet - they needed more room in their mouth to fit all of their permanent teeth once they lost their baby teeth.

OP, Phase 1 for both of my boys was between $1500 and $2000. They both had their actual permanent braces at Phase 2, which was about $4000 each. Our dental insurance paid like $1500 each (total) and then we had to pay the rest. We paid up front and received a discount from the orthodontist.

Unless surgery is involved, or a permanent set of braces, $4000 seems high for phase 1.

 

[disneychrista]

Sorry to say, but I think you are stuck. One of my boys just got braces and we negotiated the rate and signed the contract before any work was done. IMO that would have been the time to negotiate before you signed the contract.

I agree with the above.

 

[tvguy]

Orthodondist my wife and kids used charged like $100 fee to do and workup on what needed to be done, and gave an estimate that included multiple payment methods.
Too late now that you already have the braces.

Never had to worry about in or out of network, every dental plan we've had the past 35 years excluded overage for braces.