Christine Shin, DDS

Though I had been a patient for a few years, rather than tell me that Shin had gone out of network w/​my insurance co., her execrably unprofessional receptionist told me a series of fabrications (e.g., it was my insurance co’s policy change, new as of first of the year) to conceal that the dentist had actually gone out of network the summer before. (I found out the truth by calling the ins. co. after leaving the office.)
An exam and cleaning that would’ve been covered 100 percent with nothing out of pocket ended up costing me $ 370, which I had to pay upfront and was not reimbursed at 100 percent for, and used up twice the amount of my ins. benefit. Dr. Shin did not keep her word about how she would rectify the situation either. This at a time when I had just been laid off and paying $ 550 for my COBRA. Mendacity reigns at this place.
OK, here’s the deal: Know Before You Go. What’s that mean? If you have dental insurance, find out if the dentist is in-​network or out-​of-​network before you schedule an appointment. Call your insurance company or go to its website to find out, though it’s better to call; websites sometimes aren’t updated. Why’s this important?
You and/​or your employer are paying a lot for your insurance, and you want to make the most of it. You save the most money and maximize your benefit if you go to an in-​network dentist. Make sure that you understand that a dentist saying she «accepts» your insurance is not the same as being in-​network, which is the way to save the most $.
Two different companies I’ve had insurance with pay for a twice-​yearly exam and cleaning at 100 percent if you go to an in-​network dentist. Nothing up front, no co-​pay. Zip, nada, nil. The dentist gets, let’s say, around $ 150, the fee that’s negotiated with the insurer.
If you go out-​of-​network, 1) the dentist is going to bill, and get, about twice as much, say, using our example, $ 300 (these #s are approximations), and 2) she is going to want it upfront. That’s because the insurance co. is going to send you the check later, which 3) you are NOT going to be reimbursed 100 percent for, and 4) you have just used up twice the amount of your insurance benefit. This is important if you end up needing to have something like fillings, crowns or a root canal later on, things that can start to get expensive. For example: Say your annual benefit is $ 1,500, you just used up $ 300 of it rather than $ 150.
So be hyper-​vigilant and savvy. Question everything, then find your own answers independently. Don’t be bullied or believe everything a receptionist tells you. You’re better off to be very, very skeptical about everything. If something doesn’t sound right, use your cell to call the 800 number on your insurance card and find out the skinny.
You can find out, too, what your insurance company will pay for specific procedures before you go, either on the website or by calling. If you have much work done, watch what’s been paid out so you don’t go over your annual benefit; you can ask the office to get an estimate of predetermined benefits.
Do these things and you’ll save yourself a lot of headaches — and money.