Is dental insurance a good thing?
Yes! Insurance has helped millions to achieve a higher level of dental health. But it must be used correctly. Some people believe that if they don’t have insurance that they can’t afford dental work. Some people with insurance believe that if their insurance won’t pay for dental procedures, then they must not need it, or they believe it isn’t important. Others won’t spend beyond its limitations. THE TRUTH is that dental insurance provides help with getting dental work you would do anyway (you just budget differently). Not having insurance doesn’t make your teeth less important or necessary for health, social/career success, or self-confidence. Besides, you only get a limited amount of coverage anyway! Dental insurance is a good thing if you don’t let the insurance company make your health decisions for you, or think that without it you can’t afford dental care.
What is dental insurance? Insurance is a way of controlling risk and protecting yourself against a financial loss by spreading the risk of loss across a large population. Common examples include auto, home and life insurance. Premium rates and costs are determined by adding up the calculated costs of benefits paid out, plus overhead and administrative costs, plus the profits desired by the insurance company. Like any other insurance, better benefits are obtained by paying higher premiums.
What dental services are covered? What aren’t? Like any other insurance, your insurance coverage is only as good as the policy that was purchased. Many people are surprised to discover that many dental services are not covered. If you are dissatisfied with the amount or limits of your coverage it is important to discuss this with your employer and insurance company.
In an attempt to decrease their costs, dental insurance companies tend to reward prevention and limit reimbursement for complex or more involved care. In short, while they may pay well for wellness checkups and cleanings, they tend to discourage higher quality services. Higher quality and “major” treatment services may not be covered as well, or at all. The coverage available to you is solely determined by the profit structures of the insurance company and the quality of insurance purchased by you or your employer. Better insurance coverage costs more!
Why won’t my insurance pay more? Unlike major medical plans which may cover complex treatment and protect against “catastrophic loss”, all dental plans have a “stop-loss” or “Annual Maximum” which typically ranges from $1,000 to $1,500 per year. This means that regardless of your need or situation, the insurance company will not pay out more to you than this annual limit.
Who is responsible for payment? When you present for care and agree to treatment, you accept direct responsibility for paying the dental bill to the dentist, regardless of third-party coverage or assignment of benefits. Remember that your dentist works for you, not your insurance company. Our staff at Genesee Dental Group will assist you in filing insurance claim forms, but we can’t guarantee any estimated coverage.
Should I use my insurance coverage to determine my dental treatment? “No!” It is understandable that you might want to make treatment decisions based on how much coverage you have. You may even assume that your coverage will pay for all of your costs. Regrettably, this is not the case! Just as you would never choose to leave portions of your cancer untreated, you shouldn’t choose to ignore dental decay, broken teeth, toothaches, abscessed teeth, and maybe even unattractive unflattering smiles that hurt you socially or in your career.
What does it mean when my insurance company tells me my dentist’s fees “exceed usual, customary and reasonable”? What is “UCR”? “UCR” stands for Usual Customary and Reasonable. The insurance industry uses this term to try to standardize fees. It is the amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.
Why does my insurance company not pay for some procedures? The determination of whether certain procedures are covered or not is dependent on what type of policy and how much your employer pays for it. Typically, insurance will not pay for “elective” or “functional” problems that do not have their basis in trauma or pathology. Some modern dentistry and newer cosmetic procedures are likewise not covered. The purpose of dental insurance is not to be a pay-all or make you look beautiful, but to help defray the expenses associated with prevention and minor reparative work.
What is the relationship between dental fees and insurance coverage? When an insurance company policy states it will pay X % of a procedure, it is using its own fee schedule, not the dentists. Usually insurance company’s fee schedules are lower than the dentists. These fee schedules are internal to the insurance company, are determined solely by the overhead and profit motives of the insurance company, and have no relationship with the actual fees charged by the dentist. Additionally, these fee schedules will vary from area to area, despite the uniformity of the standard-of-care in our country.
Do I have to go where my insurance company says? Am I required to see a certain dentist? No! But if you have a closed or restricted plan, you may not receive the benefits unless you see their preferred doctors who have agreed to discount their services.
If you have questions about your specific dental coverage, here at your Golden, CO Dentist we are always happy to answer any insurance questions you may have. Our goal is to maximize your insurance coverage while minimizing your out-of-pocket expenses.