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updated 2/1/2011 1:14:07 PM ET 2011-02-01T18:14:07

Nearly half of Americans lack dental insurance, and every visit carries the threat of a bill for thousands of dollars.

Even those with insurance can face steep costs for major work. Patients often have to pay about 50 percent of the bill after meeting their plan's deductible. On top of that, many plans also have limits of about $1,500 for how much they will pay in a year, and some insurers won't cover pricey procedures like a dental implant.

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Here are a few tricks for saving money and trying to manage dental work costs:

Can I negotiate a bill with my dentist?
If you have insurance coverage, the dentist has already shaved 10 percent to 15 percent off his price in order to get into the insurer's network, so don't expect another discount on top of that.

If you don't have insurance, you may have some wiggle room on the price, as long as you negotiate before you have the care done. That's when you still have the power to take your business elsewhere.

Many dentists will offer around 5 percent off if you pay cash up front, said Dr. Lawrence Wallace, CEO of Larell Surgical Consultants, a California company that evaluates claims for insurers.

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Don't be afraid to ask the dentist to charge you the rate they charge insured patients. Whether the dentist is up for that can depend on how their business is doing. Wallace noted that many practices haven't recovered from a drop in patients during the recession when people lost their jobs and their coverage.

Are there discount cards or other coverage options available for the uninsured?
Some practices are so big they offer their own dental plans that give patients discounts in exchange for monthly premiums. Dentists also can connect patients with a third-party to set up a payment plan, which will tack on interest and other fees.

Some insurers and companies that form dental networks offer discount cards. These can be free or come with a premium. Before signing up for one, patients should understand how the discounts apply and make sure their dentist participates.

What about care from dental students?
Dental schools charge less for care ranging from a routine cleaning to root canals or even oral surgery.

The Indiana University School of Dentistry, for instance, charges half what a private dentist might charge for preventive care like a cleaning. Students also do filings, crowns, bridges and dentures under instructor supervision.

Dentists who go back to school for a specialty like orthodontics also provide discounted care, although dental school price breaks on this more advanced work aren't as steep as those offered for routine stuff, said Dr. George Willis, an associate dean at the school.

The tradeoff for these discounts is time. Students generally work slower than dentists, and supervisors must check their work. That means the visit will take longer than normal.

What are some other money-saving options?
Overseas dental clinics, some of which cater to foreign customers, can offer care at a fraction of U.S. costs. But follow-up care can be tricky, the patient needs time off work to travel, and liability issues can be cloudy if something goes wrong.

Anyone considering this option should ask for recommendations and look for U.S.-trained dentists or surgeons, Wallace said.

Some dentists also are open to bartering too, where a patient can trade a skill like Web design for care. Of course, the patient has to have a skill or service the dentist needs. Some dentists work participate in barter exchanges, which allow people to trade goods and services generally for barter dollars to use on other things.

Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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