'They're not super forthcoming': This dentist says don't ask if your oral health provider takes your insurance – you could end up paying $1,200 for a root canal. Do this instead

Sabina Wex
'They're not super forthcoming': This dentist says don't ask if your oral health provider takes your insurance – you could end up paying $1,200 for a root canal. Do this instead
'They're not super forthcoming': This dentist says don't ask if your oral health provider takes your insurance – you could end up paying $1,200 for a root canal. Do this instead

Have you ever wondered why trips to the dentist can be so expensive, even if you have insurance? It’s not because of inflation — it might be something you’ve said.

In a recent viral TikTok, Dr. Brady Smith responds to a commenter who asked why a root canal cost $1,200 over and above the portion of the bill covered by insurance.

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The Washington-based dentist says that the commenter’s bill probably got so high as a result of a straightforward question: "Do you take my insurance?”

“It’s a bad question,” Brady says. What you really want to ask, he suggests, is “Are you in-network with my insurance?”

“You will pay more every time at an out-of-network office, and sometimes that’s not fully transparent,” Brady says.

He goes on to say: "It's one of the less transparent yet common practices of many dental offices that are out-of-network."

Asking the right question, according to the good doctor, can mean paying $200 or $300 for a root canal instead of $1,200.

Here’s how to ensure you don’t get drilled by extra fees at the dentist office.

Know your network

It’s not enough merely to know whether your dental office will accept your insurance plan.

If the office accepts your plan but isn’t part of your insurance company’s provider network, Brady says, “they can bill the insurance company but they can tack on literally any amount that they want to.”

This is what leads to a situation where a patient pays $1,200 out of pocket for a root canal that’s also covered by insurance.

“They’re not super forthcoming in many situations with that information,” Brady adds.

Insurance companies often contractually require the dental offices in their networks to cover a full 80% of dental fees, leaving the patient to cover only 20%, known as the “co-pay,” out of pocket.

If you have employee-sponsored insurance, ask your HR rep to go through your dental benefits with you or call up your insurance company yourself to make sure you know what health providers are in-network and exactly what is and isn’t covered for you and your family.

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Don’t hoard your insurance

Most insurance plans run out by the end of the year. So even though you may not want to use every dentist dollar in January, you’re leaving money on the table by not using your dental benefits at all.

Not only are you losing money in the long term, but also in the short term. Those who skip dental visits may not realize they have serious oral health problems like gingivitis or cavities. These not only cause horrible mouth issues but also can extend to the rest of your body. For instance, the National Institute on Aging found that gum disease is linked to dementia.

By the time you get dementia, you may no longer have an employee benefits plan because you’ll be retired. And don’t think that Medicare will save you. The agency website says that it doesn’t cover “most” dental care.

So unless you have a very large emergency fund, your lack of dentist visits can create major unexpected health care costs, now and in the future.

So take advantage of your dental benefits while you have them. It’ll keep you smiling long into your old age.

Use your health savings account

If you’ve used up all your benefits, but still need more dental work done, consider using your health savings account (HSA).

An HSA functions as a savings account for health-related expenses, according to the U.S. government website Health Insurance Marketplace. Though some employees offer HSAs, you can qualify as an individual. The IRS oversees the program to ensure that you have a high-deductible health plan that qualifies you for an HSA.

The IRS has increased the 2024 maximum deductibles for HSAs to $4,150 for individuals and $8,300 for families.

Even if you don’t end up needing your HSA, you can invest the money from it. So either way, it’s a win-win for your mouth and your wallet.

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This article provides information only and should not be construed as advice. It is provided without warranty of any kind.

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