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WHAT IS DENTAL INSURANCE?
Dental Insurance is a highly complex area that creates confusion for many dental patients. The complexities of dental insurance and the lack of sufficient information provided by some insurance companies make it almost impossible for some patients to properly understand their benefits. Even more confusing is understanding how to work with your dental insurance company to achieve the highest level of benefits to which you are entitled.
Dental insurance plans are a contract between your employer and a dental insurance company. Your employer and the insurer agree on the amount your plan pays and what procedures are covered. The amount of coverage you receive will depend on the quality of the plan purchased by your employer.
Because the benefits you have are decided between your employer and the dental insurance company, some services may not be covered under your plan. The non-covered services are not based on what you need or want, but strictly on the contract with the insurance company. This is why many dental insurance companies rarely cover 100% of any dental fee. In many cases, they cover less than 50% or nothing at all. We suggest you read your plan booklet to familiarize yourself with any services not covered in your plan benefits. If you are not satisfied with the coverage provided, let your employer know.
Cost Control Measures Used by Dental Benefit Plans
Most patients do not realize that each dental insurance plan has a dollar amount limitation each year. Once this limit is reached, no other services will be covered by your dental insurance company regardless how essential the service may be to your dental health.
Dental insurance companies also have a yearly deductible amount. This amounts is taken out of the insurance payment and is paid by the patient.
Many insurance companies also apply a waiting period for certain services and will not pay for another service until the waiting period is over. In these circumstances no payment by insurance will be made.
UCR(usual, customary, and reasonable) charges are the maximum allowable amounts covered by the plan. If your dental bill is higher than the UCR, it does not mean you dentist has charged too much. Insurance companies can set whatever amount they want for UCR charges and they may not match the current fees in your area.
Your insurance plan may encourage you to choose dental care from an in-network or preferred provider. The term "preferred" means the dentist has a contract with the dental benefit plan, it does not mean these are dentists the patients prefer. If you get dental care from a dentist who is not in the network, you may or may not have higher out-of-pocket costs.
Coordination of benefits(COB) apply to patients covered by more than one dental plan. Even though you have two or more benefit plans, there is no guarantee that all of the plans will pay for your services. Each insurance company handles COB in its own way.
HOW OUR OFFICE HELPS
Our office will happy to help you receive the maximum benefits available under your policy. As a courtesy, we will file your insurance benefits for you. Please be aware that some dental insurance companies take longer than others to complete payment. If necessary, our office will contact the dental insurance company. If we are unable to obtain payment from your dental insurance company you will be responsible for the balance and contacting the insurance for payment.
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