Using Your Dental Insurance Wisely - 10 Feb, 2009

 

One of the most important things to know about your dental insurance is that your employer may change your benefits on a yearly basis. With that in mind, it is critical to understand how important continuity of care is to your health. We believe that the overall financial impact to you is reduced by maintaining a relationship with us year after year despite the fluctuating benefit levels of your policy.

 

Dental insurance can be a help to you in reducing your out-of-pocket expenses if you understand your policy. We maximize your policy benefits as much as possible. However dental insurance policies vary and in general they do not cover anything 100%. Additionally, many procedures which are necessary will not be a covered benefit by insurance plans. We can only estimate the amount your insurance will reimburse on any given procedure. We can send a ‘Pre-determination of Benefits’ to your insurance to get some idea of reimbursement. This can be helpful in budgeting treatment but is NOT A GUARANTEE OF PAYMENT.

 

Some important insurance details include:

 

- Dental insurance companies do not intend for their plans to cover all expenses. Their plans serve only as an aid toward acquiring care.

 

- Many dental plans tell their policy holders that they will be covered “up to 80% or up to 100%”. In spite of what you are told, most dentists find that the majority of plans cover about 30-40% of an average fee. Some plans pay more, some pay less. The amount your plan pays is determined by how much you or your employer paid for the plan and what benefits they chose. The less that is paid for the insurance, the less you benefit. And if you don’t pay any premium at all for your insurance, do not expect many benefits.

 

- Many dental services are covered a specific number of times in a calendar year (for example a hygiene appointment may be covered only once every six months)

 

- Insurance companies have all kinds of language they use such as “fees are above the usual and customary fees” or “treatment is not medically necessary” rather than saying “our benefits are too low” or “we don’t cover that procedure because it is too costly”.

Please do not hesitate to ask any questions about our office policies. We want you to be comfortable in dealing with these matters and we urge you to consult with us regarding services and/or fees. We will fill out and file insurance forms at no charge. We will do all we can to assure you of maximum benefits.