What you need to know about Dental Insurance!
Dental insurance is a contract between you or your employer and a dental insurance company. The benefits that you will receive are based on the terms of the contract that were negotiated between you or your employer and the dental insurance company and not your dental office. The goal of most dental insurance policies is to provide only basic care for specific dental services. The services selected are based an the cost of the policy to you or your employer and the negotiated arrangements with the dental insurance company.
Because the benefits you currently have or want are decided between you or your employer and the insurance company, many services are not covered. The selection of non-covered services is not based on what you need or want, but is based strictly on the contract with the insurance company.
Unfortunately, some of the services that you may need or want will not be covered by your dental insurer. Most dentists’ goal is to help you achieve and maintain optimal dental care, which is not necessarily the goal of your dental insurance company. The goal of the insurance company is to provide only the negotiated benefits for the specifically selected services.
The reimbursement mechanism from your dental insurance company is merely a mathematical formula as to which benefits you will receive and the percentage of the dentist’s office fee that will be paid. Another fact that most dental guests do not realize is that each dental insurance plan has a dollar amount limitation each year. Once this limit is reached, no other services will be covered by your dental insurance company regardless how essential the service may be to your dental health.
Most dental offices will do everything possible to help you understand and make the most of your dental insurance benefits. They realize that dental insurance is complex and that it is extremely difficult to understand how to make it work or even to work with certain dental insurance companies.
Some offices will complete and submit dental insurance forms to the insurance company to achieve the maximum reimbursement to which you are entitled and will work diligently to make this happen as quickly as possible. Please be aware that some dental insurance companies take longer than others to complete payment.
Many insurance companies try to control the amount of dentistry you receive by requiring authorization for procedures in advance. The authorization process is often time consuming and unnecessary.
In most cases, dentists can begin treatment prior to receiving an authorization from the dental insurance company. However, guests need to understand that in the event the dental insurance company refuses to pay for treatment, you are responsible for all fees. Dentists will provide you with the full fees in advance so that you know the exact cost of treatment.
Some services are typically not covered by dental insurance companies.These include: cosmetic dentistry, implants, occlusion or bite redesign, and other services. Although these are important dental services that can greatly enhance the quality of life, dental insurance companies do not feel that they should have to pay for these services. That is why these services are rarely included in contracts.
Dental insurance is becoming more complex and more difficult to understand everyday. This is often due to the quest by dental insurance companies to reduce costs through continual changes. Keep in mind that the dental insurance companies are not concerned about coverage for optimal dental care, but provide coverage for only a limited number of basic services.
Dental insurance companies have a fiscal obligation to do well for their shareholders. The only way they can win is to pay out less than they receive. Do your research when choosing a dental insurance company.