So you have dental insurance...

OK, so you have dental insurance.  What does it mean?  Some people think this means any dentist will see them and the insurance will pay the total bill. The reality is that most insurance policies only allow a percentage of the fee to be paid with an annual maximum.  And this percentage varies dependent on the procedure being done.  And now you ask what is going on.  Here is the skinny.  There are PPO’s, HMO’s, and traditional types of insurance.  PPO’s and HMO’s are different from traditional insurance in the way the policy is handled by the patient and the dentist as well as the reimbursement rate (that is the amount that is paid to the dentist for the work done) I will limit this discussion to the traditional type of insurance.  HMO’s and PPO’s are reserved for a later date.

First, the policy is a contract between the patient/employer and the insurance company and not the dentist.   And these policies vary widely.  Yep, some are better or worse than others.  There usually is a cap of $1000 or $1500 that is available in a twelve-month period.  And this period may be the calendar year, or the renewal date of the policy may be at the time stated in the contract.  Yep, that darn contract again.  And, if a person needs a procedure, let’s say it costs $2000, the policy will max out for that policy period.  Wow.  Yep, that a crown and root canal may max out the insurance benefits.  But there is another fly in the ointment.  Not all procedures are reimbursed at the same rate.  Some are at 100%, others at 80% and some even at 50%.  And that’s after the deductible is met.  To further complicate the situation, some procedures have no deductible while others have a deductible.  That is usually $50.  Are you confused?  This stuff is getting that way.  It even gets more complicated when pre-authorizations are required and other clauses in the contract are involved in treatment, like the replacement clause or missing tooth clause.

This may seem confusing because it is.  I think it is designed that way to discourage the acceptance and use of the insurance.  Dental offices prefer not to deal with insurance. It increases the staff work load and even may require more staff members to handle this additional work.  And to top things off, the office may not be paid within a month or two and this may result in a phone call having to be placed to receive payment.   I have waited for up to six, yes six months for the reimbursement.  So, this may be interpreted as a six-month interest free loan!  But the dental office is not a bank.  Someone needs to pay the interest.  The dental office does have expenses.  As a result, this just increases the fees at the dental office.  The interest and the cost of filing the insurance and the possibility of the follow up phone call are just added into the fee. 

So, what do we do? Don’t expect that your insurance will pay for your total dental treatment.  Discuss your benefits with your dentists.  Work with the staff to assists in receiving the payment.  Dental insurance will take the financial sting out of your treatment, just approach your dental treatment with understanding and patience.  Be sure to understand your benefits prior to beginning treatment and have an open discussion about your insurance before starting treatment.  You will not regret your decision.