Question:
These days, I'm more likely to stand up for myself. On the other hand, I
intend to be reasonable. I want what I (or rather my insurance) is paying
for. Nothing more, and nothing less.
When I get an appointment (it will be with a dentist who I have seen but
has never cleaned my teeth) for a cleaning, and if I inform them at the
time I make that appointment that it has been a long time since my last
one, am I entitled to a thorough and complete cleaning no matter how long
it takes?
Or is it accepted, not just by dentists and hygienists but also Delta
Dental, to limit the time, even if the job remains uncompleted?
My insurance pays for one cleaning per year, so I assume that coming back
for another visit would not be covered. Or will Delta Dental pay for a
cleaning that is spread over more than one visit?
Answer:
I have been a member of Delta Dental (California) for over thirty years
and I have never seen a true Delta program that limits cleanings to
once per year.
I have seen state welfare programs (which were administered by Delta)
that were limited to once a year, but never regular Delta programs.
Which Delta program do you have, and from which state's Delta? You
might want to check with them to see if there was a mistake about the
number of cleanings per year.
I attended a Delta seminar earlier this year, and was told by the
California Deltal representative that cleanings could indeed be spread
over two visits, and the dentist was entitled to charge for each visit.
I have three coverage options. "Preferred Provider" which pays 100% for
"Diagnostic / Preventive Services"; "Premier Provider" which pays 80% for
"Diagnostic / Preventive Services"; and "Non-Delta Dental Provider*" which
pays 80% for "Diagnostic / Preventive Services ... *Provider may balance
bill."
I can't find the paper I have that says how often they will pay for x-rays
and cleanings. But I am sure it was once a year for cleanings and an even
longer period for full mouth x-rays.
I emailed them with another question about my coverage and they ignored
me. I got on the phone, and was put off by the fact that you have to put
in your social security number before you can speak to any one. I don't
like that.
