As an optimum care dental practice, we strongly believe our patients deserve the best possible dental treatment we can provide. In an effort to maintain a high quality of care, we would like to share some facts and trends about dental insurance with you.
FACT #1: There is no such thing as dental insurance. Dental “insurance” is a bit of a misnomer. Your dental insurance is actually a benefit based upon a contract made between your employer and an insurance company. In most cases, insurance implies coverage in the event of an emergency or catastrophe, such as in the case of homeowners insurance or car insurance. If you were to experience a loss due to a major accident, with traditional insurance you would be liable for the deductible and your insurance company would pay everything else. With dental benefits, your policy covers a maximum dollar amount regardless of emergency, severity of your condition or catastrophe. It is simply a limited benefit and in no way is designed to “cover” all of your out of pocket expenses.
FACT #2: Dental 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 or so per year. Figuring a 6% rate of inflation per year, you should be receiving over $6000 per year in dental benefits, based on inflation alone! Your premiums have increased, but your benefits have not. Therefore, dental benefit is never a pay-all; but only an aid.
FACT #3: Usual and customary is neither usual nor customary! 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 quality private practice will have fees that insurance companies define as higher than “usual and customary”.
FACT #4: Breakdown of benefits are a guideline not a guarantee. 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. 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. Our experience with many different companies allow us to estimate coverage based on other patient’s experience.
FACT #5: Many routine dental services are NOT covered by insurance companies. In an effort to maximize insurance profits more and more routine services are not covered such as implants, tooth replacement, crowns on broken teeth and the like.
Please do not hesitate to ask any questions regarding the trends in dental benefits. At White & White, we do our very best to ensure that you are able to maximize your benefits and achieve great quality care!