Wednesday, April 13, 2011

Facts About Dental Insruance

Have you ever left a dental office confused about your insurance? This is a frustrating feeling to have.
At AIDA, we strongly believe our patients deserve the best dental care services we can provide. In an effort to better educate our patients and readers, we would like to share some facts about dental insurance with you.
Your dental insurance is based upon a contract between your employer (or yourself, if you are insured independently) and your insurance company. Should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or the insurance company directly.
Many dental offices, such as ours, offer to file your insruance electroically. This can save you time and hassle in the long run. Also, depending on the type of plan selected by your employer, insurance companies may require you to pay in full at the time of service. Insruance will then send a reimbursement check to the your home for the amount covered by your plan.

Dental insurance benefits differ greatly from traditional medical health insurance benefits and can vary quite a bit from plan to plan. When dental insurance plans first appeared in the early 1970’s most plans had a yearly maximum of $1,000. Today, some 30+ years later, most plans still have a maximum benefit of $1,000. That the premiums remained the same, allowing for a conservative yearly rate of inflation, your yearly plan maximums should be in excess of $4,500 today. Your premiums have increased, but your benefits have not. Therefore, dental insurance was never set-up to cover your services 100%; it is only an aid.

You may receive notification from your insurance company stating that dental fees are “higher than usual and customary.” Insurance companies never reveal how they determine “usual, customary and reasonable” (UCR) fees. A recent survey done in the state of Washington found at least eight different UCR fee schedules for one zip code in the Seattle area. The fees are somehow determined by taking “a percentage” of an average fee for a particular procedure in a geographic area. Average has been defined as “the worst of the best” or “the best of the worst.”

Many plans tell their participants that they will be covered “up to 80% or up to 100%,” but do not clearly specify plan fee schedule allowances, annual maximums, or limitations. It is more realistic to expect dental insurance to cover 30% to 50% of major services. Remember, the amount a plan pays is determined by how much the employer paid for the plan. You get back only what your employer puts in, less the profits of the insurance company.

Many routine dental services are not covered by insurance companies. This does not mean they aren’t necessary or appropriate, just not covered.