What does my Dental Insurance cover? Part 1

| July 23, 2010


How does dental Insurance work?  Dental benefits aren’t really insurance plans because they don’t provide coverage for a catastrophic loss.  Your dental benefit plan is an agreement to help pay for some of your dental needs.  The more your employer(or you) pays for coverage, the lower your out-of-pocket costs will be.

I am looking for a Columbus dentist that is on my dental plan?  This may surprise you but a large percentage of Columbus dentists aren’t on any dental insurance provider lists.  Many dental insurance plans allow you to go to any dentist.  The dental insurance will pay a portion of your dental bill and the remainder will be the patient responsibility.  But when you look at how much  you are paying for dental insurance(typically about 5% of what you pay each month for your medical insurance) you understand why it doesn’t cover as much.  If you want to have a wide choice of Columbus dentists to choose from, be sure to pick a dental insurance plan that allows you to choose any dentist.

How are dental plans different? Most dental plans have deductibles, maximums of the amount of $$$ they will pay per plan year, and which dental services they exclude.  Of all the dental procedures a dentist does, over half of them are excluded from most dental insurance contracts.

My dental plan covers 100%. Perhaps for some services it does but it’s 100% of what?  Many plans say they cover 100% of a filling fee but it’s not 100% of the fee the dentist charges for the filling but 100% of the fee set in the insurance companies fee schedule.

Can you waive my patient portion and accept whatever my dental insurance pays?  This seems innocent and we would like to help, however such things are considered falsified billing.

I reached the maximum of what my dental insurance will pay quickly, is that normal?  The $1000 maximum was set 40 years ago.  At that time, $1000 was considered a reasonable level of dental coverage each year.  Adjusting for inflation, your maximum should be about $5000 today, but employers have sought to keep costs down so the plans stick with the out of date maximum.