How does one find dentists who would provide cleaning under GEHA HDHP

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InvisibleAerobar
Posts: 355
Joined: Mon Jan 15, 2018 12:33 pm

How does one find dentists who would provide cleaning under GEHA HDHP

Post by InvisibleAerobar » Thu Oct 03, 2019 2:11 pm

It's really straight forward to find dentist who take GEHA Connection Dental; I'm specifically inquiring about the preventative care benefit of GEHA HDHP.

I am under (perhaps incorrect) understanding that GEHA HDHP provides 2x/year teeth cleaning on top of what GEHA Dental provides. This was touted as a benefit to GEHA HDHP.

When I looked for a new dentist (having recently moved), I specifically searched for Dentists who accept GEHA HDHP. When I contacted the dental office, the receptionist said they "take" GEHA HDHP, which I interpreted to mean for preventative care. When I actually went in, I was told that they take GEHA HDHP, in the sense that some periodental stuff are covered, but not for preventative care. Needless to say, I'm a bit miffed, as this was not what was relayed to me back when I scheduled. Had I been informed of what I was informed yesterday, I would have looked elsewhere.

But the question remains: how do those of you who employ dental cleaning under GEHA HDHP actually find your provider?

That said, all things considered, it's not too big of an issue, as I normally pay for a 3rd cleaning every year out of FSA (and LEXFSA now). But big enough an issue that I bothered to start a thread...

daheld
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Re: How does one find dentists who would provide cleaning under GEHA HDHP

Post by daheld » Thu Oct 03, 2019 2:21 pm

Call your insurer directly and talk to another human being. This way, you can ask what providers they pay and the services for which they'll pay.

seity
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Re: How does one find dentists who would provide cleaning under GEHA HDHP

Post by seity » Thu Oct 03, 2019 3:07 pm

I currently have GEHA HDHP. I have never had an 'in network' dentist on my various insurance plans because the only dentists local who are considered 'in network' near where I live are all hacks. I have used this same dentist for years and years and simply paid out of pocket.
When I switched to GEHA HDHP, I was thrilled to see they covered preventative dental 2x a year. I continue to pay my dentist at the time of service and they send in the paperwork to GEHA for me. GEHA processes the claim and send me the EOB including a check to cover the cost of my visit.
The dentist doesn't have to file the paperwork, but they do as a courtesy.
If you went to a dentist for preventative care, simply submit the claim to GEHA yourself to get reimbursed for the preventative care.

fujiters
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Re: How does one find dentists who would provide cleaning under GEHA HDHP

Post by fujiters » Thu Oct 03, 2019 3:38 pm

seity wrote:
Thu Oct 03, 2019 3:07 pm
I currently have GEHA HDHP. I have never had an 'in network' dentist on my various insurance plans because the only dentists local who are considered 'in network' near where I live are all hacks. I have used this same dentist for years and years and simply paid out of pocket.
When I switched to GEHA HDHP, I was thrilled to see they covered preventative dental 2x a year. I continue to pay my dentist at the time of service and they send in the paperwork to GEHA for me. GEHA processes the claim and send me the EOB including a check to cover the cost of my visit.
The dentist doesn't have to file the paperwork, but they do as a courtesy.
If you went to a dentist for preventative care, simply submit the claim to GEHA yourself to get reimbursed for the preventative care.
This has also been my experience.
“The purpose of the margin of safety is to render the forecast unnecessary.” -Benjamin Graham

Topic Author
InvisibleAerobar
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Re: How does one find dentists who would provide cleaning under GEHA HDHP

Post by InvisibleAerobar » Fri Oct 04, 2019 9:00 am

Thanks to everyone for chiming in. Just to confirm, is it a fixed fee that GEHA remits after the fact, and the policy holder will end up paying extra? Or would it be a percentage that GEHA remits? If it's the latter, what does GEHA consider to be "standard and reasonable" for cleaning?

So for instance, cleaning cost $100. I send an itemized bill to GEHA. GEHA has a fixed payment (of say $85); it sends me a check for $85 and I end up paying $15 (from my LEXFSA). Or alternatively, the bill is $70. GEHA sends a $70 check to me.

vs.

Say 90% of incurred charges up to $120.

vasaver
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Re: How does one find dentists who would provide cleaning under GEHA HDHP

Post by vasaver » Fri Oct 04, 2019 10:16 am

InvisibleAerobar wrote:
Fri Oct 04, 2019 9:00 am
Thanks to everyone for chiming in. Just to confirm, is it a fixed fee that GEHA remits after the fact, and the policy holder will end up paying extra? Or would it be a percentage that GEHA remits? If it's the latter, what does GEHA consider to be "standard and reasonable" for cleaning?

So for instance, cleaning cost $100. I send an itemized bill to GEHA. GEHA has a fixed payment (of say $85); it sends me a check for $85 and I end up paying $15 (from my LEXFSA). Or alternatively, the bill is $70. GEHA sends a $70 check to me.

vs.

Say 90% of incurred charges up to $120.
Both of our dentists are "out of network" - 2 adults / 2 kids. They both bill GEHA directly. I think they would have to do this if you have an in-network dental plan as well because the FEHB healthcare plan should be primary and dental secondary?

Our experience is that GEHA pays a fixed amount to the out of network dentist - I believe this amount depends on the Rating Area. Our out of network dentist bills GEHA and then charges us about $10 extra for Cleaning / XRAYs. So my last cleaning was about $250, GEHA paid $240 and we received a bill for $10.

Our pediatric dentist doesn't charge extra, just takes the GEHA payment.

Dropping AETNA Dental saves about $1500/year in premiums. We may add it back on when the kids get braces if it makes sense. We did put extra money in the limited purpose FSA that I will need to figure out how to spend if we don't need any extra dental work. Since we dropped dental last year we haven't had any major dental work.

Topic Author
InvisibleAerobar
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Re: How does one find dentists who would provide cleaning under GEHA HDHP

Post by InvisibleAerobar » Fri Oct 04, 2019 11:49 am

Understood; many thanks for the detailed response

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