The number of people covered by dental insurance has increased tremendously in the past 40 years. Since dental insurance is a major fringe benefit in many major companies, it is rapidly playing an increasing larger role in helping people to obtain much needed dental treatment.
We strongly feel that our patients deserve the best possible dental care we can provide. In an effort to maintain this high quality care, we would like to share with you some facts about dental insurance and how it works.
Dental insurance is meant to be an aid to help restore your mouth to sound dental health. It has been the experience of many dentists that patients have gotten the impression their plan will pay up to 80%, even 100% of their dental fees. In spite of what you are told, we’ve found many plans cover about 40% to 50% of an average fee. For the same procedure, some plans pay more – some less. Insurance coverage is a matter between your employer and the insurance company. We are not involved with any insurance company and therefore your benefits are not determined by our office. The amount your plan pays is determined by how much your employer paid for the plan. The less paid for insurance, the less you will receive.
It has been the experience of many dentists that sometimes insurance companies tell their clients that certain dental fees are “above the usual and customary” or UCR, rather than tell them that the insurance benefits are too low. We know that some insurance companies do not upgrade fee schedules, even with the cost of living index. Dental insurance in the 1960’s paid out an average of $1,000 of dental benefits per year. Today, more than 40 years later, the average is still $1,000. Remember, since the insurance company must make a profit, you can only get back in benefits what your employer puts in, less the profit the insurance company wants to make (i.e. the less they pay, the more they profit).
The insurance company is responsible to the patient. We strongly suggest that you become familiar with your dental coverage. We will cooperate in any way we can to help you obtain the maximum benefit that you have paid for. Please read your policy so that you are fully aware of any limitation of the benefits provided. Many routine and recommended dental services are not covered by insurance carriers. In fact, some preventive procedures are not covered at all. There are a number of clauses insurance companies use to deny payment, such as pre-existing conditions and alternate (cheaper) benefits.