Patients Guide to Dental Insurance
Patients are often confused about their dental benefits and how they work. It is important for patients to understand that the dental insurance dollar amount that a patient receives is based on what the employer has chosen for his/her employees. That is, the more the employer pays into the benefit, the more the insurance will reimburse the dentist or patient.
There exists no dental insurance to our knowledge that will cover all of the costs for a patient. Some pay on a fixed dollar amount, while others pay on a percentage basis. We have often found that patients will call our office telling us that the insurance will cover 80% of their treatments, but in reality, the plan only pays 80% of a preset fee schedule, which reflects fees much lower than what is commonly found in a high quality private practice. Other limitations that are found with dental insurances are the annual maximums, which unfortunately have not changed in almost 40 years.
Types of Dental Insurances
- PPOs- preferred provider organizations
- DMOs-dental maintenance organizations similar to medical HMOs
The traditional dental insurance is the plan that offers patients the greatest freedom to visit the dentist of their choice. However, they cost the employer significantly more money than a PPO or DMO.
Patients often ask us if we need to discuss the proposed treatment plan with the insurance company prior to beginning treatment. We stress to our patients that we like to be completely independent of the insurance company. We advise you of our findings and our recommendations are based upon the most predictable long-term therapy. The ultimate decision for a lifetime strategy for optimal dental health must come from a team approach between the patient and our office and not be limited by the insurance companies.
What is UCR-"usual and customary fees"?
We have found that the more expensive your insurance policy is, the less you have to worry about the term UCR. When an insurance company notifies a patient that the dentist's fee is beyond the usual and customary fee for that area, it is trying to pay the lesser amount for that area. Each dentist has fees set according to what he/she believes is fair compensation for the treatment rendered. The level of care, amount of time for the procedure, the materials and laboratory used, are all factors that each dentist uses to establish his/her fees. Insurance companies exist for profit, and therefore will look to pay the lesser amounts at all times.
Who is responsible for financial arrangements?
The fees are ultimately the responsibility of the patient. We stress to our patients that we are working for them and with them and not for the insurance company. It is therefore the patient's complete responsibility for all financial arrangements made with our office. We will try to work with your insurance company if it is a traditional indemnity plan when applicable, but the ultimate responsibility lies with the patient. Our staff will help you to file for reimbursement and to better understand your benefits. Our financial coordinator can also help develop a financial plan with us that will make dental care affordable within your budget. Please call our office to discuss this in greater detail.