1. How does dental insurance work?
Dental benefits are not really insurance plans. They are agreements to help pay for some of your dental needs. The more your employer pays for coverage, the lower your out of pocket costs will be. However, whatever your benefits, they are a good gift to have.
2. Does my plan cover 100%?
Perhaps for some services, but never for all. Plus the 100% may be on an artificial fee, rather than what any dentist in your area charges. Take an X-ray for example. A good plan may set coverage at $20.00, a middle plan at $10.00, and a low priced plan may exclude it all together. Yet all the plans may claim to cover X-rays at 100%.
3. Can you waive my portion and accept whatever insurance pays?
This seems innocent and we would like to help. However, such acts are considered Insurance fraud, this is Illegal and we do not do this.
4. Can you change codes, or dates, to get me better coverage?
Insurance carriers inspect records. Your x-rays, lab slips and chart tell a true story. If fraud is committed, you and your dentist can be fined or imprisoned.
5. Why can you only estimate my coverage?
Insurance companies have 1000’s of plans, and they refuse to release the details of their plans. They change policies and reimbursements constantly without notice.
6. Why not send written estimates?
Pre-authorizations are rarely required, despite contract language that is designed to suggest otherwise. The process is so long and frustrating that statistically nearly 70% of estimate work never gets done. Plus carriers rarely disclose what the actual dollar amount will be anyway. Pre estimates are a waste of time.
7. What if my spouse has insurance?
Dental plans used to work together. However, many times you will get little or no coverage from a second plan anymore. Consider any extra benefit a gift.
8. Do you take medical Insurance?
Medical plans do not cover dental services, except for a few situations, such as accidents and some oral surgery.
9. Does dental insurance have to be so complicated?
No. Many companies are switching to “direct reimbursement plans”. These are so clear and simple that they cut administration costs by 50% or more. Most employers do not know about them. For more information, have them call the American Dental Association at 800-621-8099 Ext 7746.
10. How do you handle my insurance?
We are happy to process your paperwork for you. We will approximate your coverage and ask for your estimated co-payment. After insurance pays we will reconcile any differences. Whatever your coverage, please remember that you are ultimately responsible for payment.
11. Why do you collect co-payments automatically?
The more paperwork and administration costs we eliminate, the more savings we can pass on to you.
Dental Insurance Terms:
Dental insurance provides benefits. However, there are several confusing provisions in the “fine print” of most contracts. Some common terms to know:
UCR (Usual, Customary and Reasonable):
Usual, customary and reasonable charges (UCR) are the maximum amount that will be covered by the plan for eligible services. The plan pays an established percentage of the dentists fee or pays the plan sponsors “customary” or “reasonable” fee limit, whichever is less. Although these limits are called “customary” they may or may not reflect the fees that area dentists charge. Exceeding the plans customary fee, however, does not mean your dentist has overcharged for the procedure. Why? There are no regulations as to how insurance companies determine reimbursement through the contract with the insurance company. The patient is usually responsible for paying costs above the annual maximum. Even though the cost of dental care has significantly increased over the years, the maximum levels of insurance reimbursements have remained the same since the late 1960’s. Your employer may want to research plans that offer higher annual maximums.
How much you have to pay before your insurance begins to pay.
The most you can spend of your insurance company’s money each year.