How to Manage Dental Costs, With or Without Insurance

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By Suzanne DeChillo of The New York Times

For most people, a toothache that turns into an expensive procedure like a crown or implant means thousands of dollars out of pocket. Routine checkups, cleanings and fillings can set you back hundreds. No wonder 35 percent of Americans have not visited a dentist in the last 12 months, according to a Gallup report in March.

Even if you’re fortunate enough to have some kind of coverage, you have probably discovered just how little it pays if you have big problems. Most dental policies pay for preventive care like twice-a-year checkups, but cover only a fraction of higher-cost procedures like root canals. Even fillings can get short-changed, if the insurer decides the tooth-colored filler the dentist used was too "cosmetic" for the pothole being patched.

At the same time, dental care costs are rising faster than inflation, just as the evidence mounts that taking care of your mouth can be a critical gateway to good overall health.

The health care bills circulating in the House and Senate include dental care provisions for children, which is good. But it also means that for most of us relief from dental bills is not likely to come soon. That leaves it up to consumers to find smart ways to reduce their dental care costs without sacrificing their oral health. So we asked experts and patients for advice.

PREVENTION
Taking care of small problems keeps them from becoming big ones. Enough cannot be said about prevention, according to Dr. Matthew Messina, consumer adviser for the American Dental Association and a dentist in Cleveland.

Left unchecked, a small cavity that would cost about $100 to fill can easily turn into a $1,000 root canal. Skip those $80 cleanings each year, and you may be looking at $2,000 worth of gum disease treatments. An abscess that lands you in the emergency room will set you back hundreds of dollars for the visit, “and you’ll still have to go see a dentist, because emergency rooms don’t handle dental work,” said Dr. Messina.

Finally, your dentist also routinely looks for more serious problems, like oral cancer. More than 35,000 cases are diagnosed each year, according to the American Cancer Society. Early detection, usually during a dental checkup, is critical to successful treatment.

FULL DISCLOSURE
It’s important to know the price before you agree to the procedure. Often patients sit down for a routine cleaning and checkup, only to find they have a problem. The dentist offers to take care of the situation on the spot, and the patient agrees — but then is socked with a surprising bill at the end of the visit.

That happened to Monica Gagnier of Beacon, N.Y., on a recent visit to her Manhattan dentist for a twice-yearly cleaning. Looking to save money, Ms. Gagnier was careful to tell the office when she made the appointment that she wasn’t due to get X-rays and didn’t need to see the dentist for a checkup. Without those two items, she figured she would save more than $100 on her bill. During the cleaning, however, the hygienist told her that her gums were infected and she needed antibiotic shots. Her total bill was $400.

“The antibiotics may well have been necessary,” Ms. Gagnier said. “But what I hate is being hit by surprise costs and treatments when I’m lying on my back, my mouth is wide open, and I can’t talk about it.”

You should always be given an opportunity to discuss any treatment, sitting up, without equipment in your mouth, says Dr. Messina. In addition, whenever you are facing an invasive dental procedure that is not an emergency, it makes sense to refuse treatment on the spot and get a second opinion, says Elizabeth Rogers, a spokeswoman for Oral Health America, a nonprofit advocacy and education group based in Chicago.

The range of prices on treatments like root canals, for instance, can easily differ by $1,000 or more.

SPREADING THE COST
Patients can often space out treatments or negotiate payment plans with the dentist for extensive work. Working with the dentist on payments, says Dr. Mark Wolff, associate dean at the New York University College of Dentistry, is much better than putting the bill on your credit card and paying high interest.

Another way to negotiate, says Dr. Wolff, is to plan extensive treatments in phases. Say you need a crown. Your dentist may be able to put in a temporary filling for several months while you use that time to save for the permanent crown. “It’s quite possible to phase in many dental procedures,” said Dr. Wolff. “And when it is, most dentists are willing to spread the work out over time.”

DENTAL SCHOOLS
Almost every dental school offers affordable care provided by dental students and overseen by experienced, qualified teachers. You can expect to pay as little as a third of what a traditional dentist would charge and still receive excellent, well-supervised care, Dr. Wolff says.

That is what Julie Kingsley of Portland, Me., did after a checkup for her two young children at a pediatric dentist set her back a total of $375. “I realized that was as much as a car payment or a good chunk of our monthly food bill,” said Ms. Kingsley. “There had to be a better way.”

Ms. Kingsley started asking around for less expensive alternatives and found out about the University of New England’s dental college clinic, at the Westbrook campus in Portland. The bill for her children’s latest checkups: $100. Ms. Kingsley was pleased with the quality of care her children received. But she did warn that patients may sacrifice time for money. “What was a 45-minute visit at the private dentist ended up taking three hours at the clinic,” she said.

If you have trouble finding a dental clinic in your area, you can seek help from Oral Health America (312-836-9900).

DISCOUNT NETWORKS
Alternatives to employer-provided dental insurance are often a bad deal, Dr. Wolff said. But for the uninsured, a discount network can make a difference.

Some networks like those on DentalPlans.com have formed to fill the void. Consumers pay roughly $100 to $200 a year in exchange for 15 to 50 percent discounts on service and treatments from participating dentists. “Be sure to compare plans carefully,” said Ms. Rogers of Oral Health America. And, she added, make sure the discounts you are likely to use will be enough to cover the annual fee — and look carefully for any limits and restrictions.

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