Do you have dental insurance? If yes, how well do you understand your dental insurance policy? Most often than not, patients who have dental insurance have a hard time understanding their dental insurance policy. There are many dental insurance plans and policies to choose from or that you have but may not be familiar with.
So, what do you need to know about dental insurance? We have listed 5 things you need to know about dental insurances when it comes to using it in dental clinics.
#1: Dental insurance is not like medical insurance.
What do we mean? Your dental insurance isn’t insurance but benefits. Dental insurance is not intended to pay a significant portion of your dental expenses but be an aid. Dental insurance provided by an employer usually covers a part of the cost of dental services.
#2: They are typically described as “100-80-50” coverage.
Dental insurances can say they cover 100%, but that is dependent on how much your employer paid for the plan. The less they spend, the less you receive in benefits. Usually, 100% of the coverage goes to preventative and diagnostic care, 80% to 70% on basic procedures and 50% or less on significant treatments. Again this is dependent on the plan an employer has purchased for their employers.
#3: You receive what your employer pays.
If your employer pays less for dental insurance that is what you will get, what they put in. The less the insurance funds, the more you will need to pay for your dental expenses. The fees dental clinics charge are the same for each patient regardless of the dental insurance you have. So, if you have to pay more, look carefully at how much your dental insurance is covering. Also note, most dental insurances will not cover all preventative care which is why getting your dental benefits explained is essential to know what is being included.
#4: Insurance encourages you to use providers within their network.
Often you will find that insurances have a list of “preferred providers”. What it means is, you will be given a list of providers who have agreed to reduce their fees to what insurances want. In these cases, the dentist on this list has agreed to add restrictions which have been placed by entering into a networking plan of “preferred provider”. When restrictions and reduced fees are agreed upon so are the quality of the work and materials used since most practices will have to keep costs low to meet the agreement between the insurance.
#5: Dentists don’t work for dental insurance companies.
Why is this important to know? Because some patients expect dentists to submit claims for them and figure out insurance issues they may be having trouble with. Yes, although some dental practices offer to send claims to insurances, it does not mean they work for insurance companies. They are just adding value to their patients by helping them submit applications with the necessary documentation. If you receive a notification from the insurance company saying they have not received the documents needed, verify with your dentist with when they submitted the claim and call your insurance before getting mad, again keep in mind dentist, and dental staff does not work of the insurance company.
We recommend before you start using your dental insurance, you get a copy of your dental policy to become more aware of what is being covered and at what percentage it is willing to cover. Remember dental insurance is not insurance, it is dental benefits which help you cover partial expenses of your dental treatment and preventative care. If you have questions of what’s included, we encourage you to ask your insurance company or employer and if you want to know if your dentist will take your insurance to ask them.