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As an optimum care dental practice, we strongly believe our patients deserve the best possible services we can provide. In an effort to maintain a high quality of care, we would like to share some facts about dental insurance with you.
Your dental insurance is based upon a contract made between your employer and an insurance company. Should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or insurance company directly.
Dental insurance benefits differ greatly from general health insurance benefits. In 1971, your dental insurance benefits were approximately $1000 per year. Some 35 years later, you will note that your benefits are still $1000 per year. Figuring a 6% rate of inflation per year, you should be receiving over $5000 per year in dental benefits. Your premiums have increased, but your benefits have not. Therefore, dental insurance is never a pay-all; it is only an aid.
You may receive notification from your insurance company stating that dental fees are "higher than usual and customary". An insurance company surveys a geographic area, calculates an average fee, takes 80% of that fee and considers it customary. Included in this survey are discount dental clinics and managed care facilities which bring down the average. Any doctor in a high quality private practice will have fees that insurance companies define as higher than "usual and customary".
Many plans tell their participants that they will be covered "up to 80% or up to 100%" but do not clearly specify plan schedule allowance, annual maximum or limitations. For example: Some dental plans will downgrade composite filling fees (tooth colored fillings) to amalgam filling fees (silver fillings) on posterior teeth. Therefore, your out-of-pocket cost will be increased. It is more realistic to expect dental insurance to cover 35% to 65% 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 put in, less the profits of the insurance company.
Please do not hesitate to ask us any questions about insurance and our office policies.