Negotiating with Orthodontist

[mjkacmom]

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

LOL - $6500 for dd18 and $6500 for ds16 - but insurance paid $3000, so only $10,000.

 

[ceecee]

Around here most specialists are out of network. They should bill your insurance, maybe they will pay a lower fee but usually insurance has a max of $1500. So if they pay 50% in network and 30% out of network you may get some coverage. At our office we have a lot of patients who have PPO plans but the coverage is almost the same. There are a few plans that do not offer out of network at all, but not a lot.

 

[DreamIsaWish]

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.

I think it's probably a bit high, but not as high as you're thinking. For my son, phase 1 is including a set of "real" braces on the top but nothing on the bottom (I'm not sure what you're meaning by "permanent" braces but I think what's you're meaning is what he's getting. His braces on top sure look like the ones I had as a kid.)

And I'm also learning from reading all the responses to my original post, orthodonture prices vary hugely! And I've learned that no matter what, this is not a cheap adventure and I should count myself lucky that our dental plan covers anything out of network.

 

[DreamIsaWish]

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

Yes, it only covers Phase 1. So you raise a good point about Phase 2 and shopping around at that point. I didn't even think that far ahead because the $$$ for Phase 1 (and the fact that they were mentioning multiple phases at all) caught me off guard.

It seems I may have underestimated orthodontics and am definitely recovering from sticker shock. On the upside, my husband felt so bad that he negotiated with AT&T to save $300 on our bill this year to make up for some of the in-network vs. out-network difference.

Thank you all for sharing your experiences and giving me a few ideas in a suboptimal situation.

 

[tarheel618]

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

Ours was the same way.

 

[teller80]

I don't know about dental, but for glasses it was cheaper for me to go out of network than in network. And I also think $4k is very reasonable, I paid $5k eight years ago. I'm thinking it's not as bad as you thought.

But I'm confused on the timing. You said your husband agreed to it at the initial consultation. The work started that day? There couldn't have been much done - xrays, a mold... Surely you could of backed out at that point?

And is your husband typically impulsive?

 

[Jajone]

The orthodontist put the braces on the same day as the consult? Around here that is unheard of. Do you have a dental associates in your area? They have a secondary dental policy we buy for $25/year and it took another $1500 off braces. Just had my second child's on and total OOP for both kids so far is $3500. and that includes wisdom teeth removal for my oldest too.

 

[DreamIsaWish]

The orthodontist put the braces on the same day as the consult? Around here that is unheard of. Do you have a dental associates in your area? They have a secondary dental policy we buy for $25/year and it took another $1500 off braces. Just had my second child's on and total OOP for both kids so far is $3500. and that includes wisdom teeth removal for my oldest too.

I didn't expect the braces to go on that same day, either. The office had a bunch of cancellations (severe cold caused school closures) and they offered to do it that day because it would be more convenient than a during-school appointment later. I was shocked that evening when I saw him with braces.

 

[kuhltiffany]

I didn't expect the braces to go on that same day, either. The office had a bunch of cancellations (severe cold caused school closures) and they offered to do it that day because it would be more convenient than a during-school appointment later. I was shocked that evening when I saw him with braces.

Never heard of that either, we've been to 3 orthodontists (moved, 2 consults), and all started with x-Rays, moulds and a later meeting with the results to present the plan/options...

 

[ceecee]

They usually do impressions, several xrays and then the tx plan, that office must have been wanting to get him before he changed his mind! Probably put the brackets on and then decided how to move them for the next appt. Surprising that the office didn't check your insurance prior to this.

 

[Jajone]

A little shady of the office, especially when insurance is involved.

 

[smadath]

If your Health Insurance Plan includes an HSA (health savings account), you can use it to pay for braces. It won't be an enormous saving, but it will be a pre-tax expense. Plus, that would be money already earmarked for that type of expense.

 

[havaneselover]

If your Health Insurance Plan includes an HSA (health savings account), you can use it to pay for braces. It won't be an enormous saving, but it will be a pre-tax expense. Plus, that would be money already earmarked for that type of expense.

This is what I'll be doing. The savings actually can be decent. I'll save about 21% (which is a lot on two sets of braces), but I'm in a 15% federal tax bracket. If you're in a higher tax bracket and/or can have the contributions made on a pre-tax basis (so you're avoiding FICA, etc.) it can be much higher.

 

[LuvOrlando]

I negotiated a payment schedule that allowed me to equalize with Ins & my flex spending account.

Protocol & payments seem to average 2+ years.
Ins paid in quarters regardless of how i paid grrr
I offered the office accountant a big fat check at the beginning of each year (jan or Feb) so I could make the fsa submission in bulk to take that weight off monthly budgeting & so they would extend the payments across the full time period which was a little longer than normal. They accomodated me because i was one less patient who could default. I had to submit the payment plan to fsa along with the check receipt so it would match up and it did. We are now at the end of the braces time and I was done with payments last Feb so it was nice to remove the weight of it. I win because my money wasn't tied up (i got reimbursed from fsa in a month or so instead of dealing with it all year) and Dr won because my payments for 2+ years were paid off in about 14 months- now I just show up with my girl & its done when its done.

Maybe they will allowa longer payment period with smaller payments to ease the damage this year if you give big chunk checks like I did, the office seemed to like it. Possibly offer a credit card on file as a backup plan for them to make things easier for them.

Good luck

 

[LuvOrlando]

^you could offer to make 3 years of payments within about 24 months or so

Jan 2015. 1/3
Jan2016 1/3
Jan2017 1/3

 

[photos_101]

DS18 Just got his braces off a few months ago. We spent well over $12,000 (almost all oop) for everything that needed to be done. He had to have several baby teeth removed, a couple of minor surgeries including an implant/crown(which ins. paid NOTHING on and that alone was $4000!! and then the cost of the braces(2yrs worth of monthly appts included). The braces alone were $5600 and our insurance only paid $1500 towards them.

His ortho set up a contract and allowed us to make monthly pmyts for 2yrs. I of course hated the thoughts of $200mo EVERY month for that long so I paid it off very quickly.
NOTHING was done the first day except a consultation. We had a couple months of prep work before the braces could even be put on. Molds were taken and sent off for a complete evaluation of them and a 2yr plan was drawn up with each stage showing what/when things would need to be done. Xrays were done and more consultations describing how things would play out.
This is alot of time and money spent and I would want it done correctly and with the best course of action for my son. To me this takes time, planning and consultations with the ortho. It should not have all been done on that same day.

He didn't have to do 'phases'. I am not sure what all that entails. He is now in invisible type retainers which he wears to keep the teeth aligned.
He has a beautiful smile and a much healthier mouth. Money well spent!

OP I hope things work out for you but I would just chalk it up as a life/financial lesson and work out the best plan to move forward. Accepting it all may be a better stress reliever than fighting it.

 

[ceecee]

As I work in the dental field, I was fortunate enough to get a 35% professional discount since I used someone we refer to. Just keep in mind, you can get several opinions (usually not a charge) a lot of orthodontists are getting away from the Phase I and II and waiting a little until all permanent teeth are in. A palatal expander can be helpful, but some of the other reasons are just a $ maker and the child is in braces a lot longer, which means if they don't keep them clean more decay. A lot of opinions on this.