Dental Insurance Update:
Dental Insurance is more like a coupon to apply towards your dental treatment NOT like health insurance, car insurance or really any other kind of insurance you may have. Dental Insurance often has a low annual maximum amount they will reimburse and usually only pay about half of any expensive/major dental treatment.
Additionally dental insurance is difficult to clearly use to your full advantage. We often we see patients who have dental insurance but do not use it to their greatest benefit and are disappointed with the coverage. This is usually true because they don’t know best how to use it or what exactly is “dental insurance.” Remember: “Dental Insurance is very different than health insurance.”
Dental insurance is a contract between the patient, the employer (or plan sponsor) and the insurance company. This is very different than health insurance where there is often a contract between the insurance company and the doctor. In that arrangement there is predetermined fee schedule and agreed upon co-pays.
There are many different ways plans are designed with dental insurance and they can vary greatly. The most common components of dental insurance can be tricky to understand. They include the benefit period, yearly deductable, the maximum amount the insurance will pay in a given benefit period and percents of benefits paid for different levels of dental treatment.
Typically insurance coverage runs by the calendar year, however this can vary according to individual company’s policies. Some companies use their fiscal year or mid-year as their reset date for dental insurance.
Most traditional plans have a one-time yearly deductable of $50. What this means is that at the beginning of every insurance plan year the first non-preventative procedure is $50 is out of the patient’s pocket.
The maximum cumulative coverage for a “benefit year” is usually $1000 to $1500. This is often a surprise to patients because regardless of how much dental treatment they may need, the dental insurance company’s responsibility is often capped at a relatively low amount.
Dental insurance pays at a variable rate, depending on what category of dental treatment is being rendered. Most dental insurance plans usually pay 100% of preventative dental treatment such as cleanings and x-rays, 80% of restorative dentistry such as fillings and 50% of major services such as crowns and bridges. The amount paid by insurance companies in each of these categories can vary widely.
The gray part of the “percent paid” is based on how much the insurance plan “allows” on any particular service code. There is a common misconception that 100% means 100%, and 80% means 80%, etc. The amount the plan allows is usually gathered from a broad geographic range of locations by insurance companies; they vary greatly and really are not indicator of fair market dental fees. This is often a number that works to the advantage of the insurance company.
The take home message with dental insurance is that the patient should do their due diligence in familiarizing themselves with their dental insurance plan. It is important to recognize that the components of dental insurance mentioned above can have a big impact on their financial liability. Further the patient should ask for a written treatment outline for all planned dental treatment from their dentist so that they can compare this with their insurance plan in advance to avoid unnecessary financial surprises.
Drs. David and Janna Civils
1114 Magnolia Street