Get to know your dental insuranceGrandviewDental | August 19, 2008
It’s a contract between your Employer and the Insurance Company
Your dental insurance is based upon a contract made between your employer and an insurance company. This contract determines:
- What your employer pays for the dental benefit which in turn effects what you pay
- What sort of dental procedures your plan will cover. Many plans don’t cover procedures that have been the standard of care for over a decade. (tooth colored fillings, dental implants, etc)
- The fee schedule or how much money will be paid for particular procedures and how much you the patient will have to pay
- How much coverage you have each year in dental benefits
- Whether or not you can choose any dentist or have to pick a dentist from a list
We don’t have the insurance company magic phone number
Believe it or not we don’t have a magic phone number or a designated contact at the insurance company. We submit claims to 100s of different insurance companies. Multiply that by the number of employers with different flavors of policies with those same insurance companies and it becomes challenging to get the definitive answers to our patients questions.
We will make reasonable attempts to contact the insurance company to get things resolved but patients must play a role also to be successful.
We don’t know exactly what your insurance company will pay until we receive the claim back
We will always be able to tell you what our fee is for a particular dental procedure and we can usually estimate what your insurance will pay. But until we get the claim back we don’t know for sure what your insurance company will pay.
We understand that this makes it very difficult for you to budget on bigger procedures and offer a variety of payment options so that you can get the dental care you need.
Dental insurance benefits are different than health insurance
Dental insurance benefits differ greatly from general health insurance benefits, in both coverage and price. Do you know what you pay for your dental insurance? Check your pay stub and compare it to the cost of your medical coverage. Big, difference, eh?
Knowing that dental insurance isn’t really insurance (coverage for a chatostophic loss) it’s more of resource for payment. Know that the big stuff is still going to have some out of pocket cost and that there is a maximum you can use each year.
But also realize that the big stuff doesn’t happen year after year. You may have a year with a root canal and a crown(big stuff) but then have “ok” check-up appointments for the next 5. And remember, that small filling the dentist found today will eventually turn into something bigger and more expensive if you don’t get it taken care of. The decay doesn’t go away…. it just gets bigger.
Dental Benefits have not ever increased
In 1971, your dental insurance benefits were approximately $1000 per year. Some 35 years later, you will note that your benefits are still approximately $1000 per year. Figuring a 6% rate of inflation per year, you should be receiving over $5000 per year in dental benefits. Your premiums have increased, but your benefits have not. Therefore, dental insurance is never a pay-all; it is only an aid.