Insurance Facts

FACT #1

Dental insurance is meant to be only an aid to help complete preventative dentistry (i.e. exams, cleaning, and films) or restore your mouth to sound dental health. It has been the experience of Dr. Thomas along with many dentists, that patients have the impression their plan will play up to 80-100% of their dental fees. In spite of what patients are told we have found many plans cover 40-50% of an average fee. For the same procedure some plans may pay even more or less. The amount your insurance plan pays is determined solely by the amount your employer paid for that plan. The more the employer paid for the plan the more the plan pays and vice versa. In other words, did they purchase the luxury car or the economy car?

FACT #2

Many dentists have had the experience that sometimes insurance companies tell their subscribers that certain dental fees are "above the usual and customary" or UCR, rather than tell them that the insurance benefit allowances are too low. We know that some insurance companies do not upgrade fee schedules, even though the cost of living increases. In the 1970's, dental insurance paid an average of $1,000 for dental benefits per year. Today, that average is still $1,000. Since the insurance needs to make a profit, they will only pay out what your employer puts in; the less they pay the higher the profit.

FACT #3

Please read your policy handbook so you are fully aware of any benefits not provided. Many recommended and routine dental services are not covered by your insurance carrier. Some preventative procedures are not covered at all. There are many phrases that insurance companies use to deny payment such as alternate benefits which are cheaper and pre-existing conditions.

FACT #4

As a courtesy to our patients, we are more than happy to fill out the forms and submit the dental claims to the insurance carriers.

FACT #5

We submit the insurance after each visit. However, the patient is responsible for the total fee for the visit and will be expected to make up any differences in the insurance coverage. We are here to help you sort through the confusions related to the dental insurance and are happy to discuss our policies and fees with you at any time. We can provide you with an estimate of what the insurance should cover, but remember that this is only an estimate.

SUMMARY

  • Fees for services rendered are the same charged to all patients for those services regardless if the patient is covered by dental insurance or not.
  • Your insurance may base its payments on a fee schedule, which may or may not coincide with current acceptable fees in our area.
  • Therefore, BENEFITS HAVE NOTHING TO DO WITH THE FEES CHARGED.
  • Insurance policies vary greatly in the types of coverage they provide even within the same company. The patient's insurance policy is responsible to the patient; we urge you to become familiar with your dental coverage. We will do all that we can to help you receive the maximum benefit that you purchased.
  • ALL PATIENTS ARE FINANCIALLY RESPONSIBLE FOR THEIR OWN ACCOUNTS
  • Finally, your insurance coverage is a matter between your employer and the insurance company. Your benefits are not, in any way, determined by our office; we simply submit the paperwork for the services rendered.

Questions to ask regarding your dental benefits:

  1. What types of dental coverage are offered by your employer or union?
  2. Which procedures does your dental plan limit or exclude? Do certain procedures have waiting periods?
  3. How are your benefits calculated? (UCR of Table of Allowances?)
  4. Does your plan allow pre-determination of benefits?
  5. Does your plan impose an annual maximum benefit level?
  6. What are your co-payments?
  7. Does your policy cover only the least expensive alternate treatment?