Facts About Dental Insurance
Facts You Should Know About Dental Insurance
Myth #1: My insurance reviews my dental claims and makes sure the correct treatment was done.
Fact: Claims are not read and reviewed by dentists. A “claims specialist” will review the claim, apply the plan provisions, and process the claim for payment. Your insurance company will pay for the most economical restoration that your plan allows for, rather than the best option for you. It is important to remember that reimbursement and benefit levels are based on what plan your employer has selected. The more money your employer pays the better the plan benefit. Dental insurance plans are a business arrangement between an insurance company and your employer. We have absolutely no influence on what they will cover and how much …show more content…
they reimburse.
Myth #2: If I have a good medical plan then my dental plan must be good too.
Fact: Dental insurance benefits differ greatly from general health insurance benefits. Medical benefits have gradually increased, while dental insurance benefits have been at a standstill for almost 40 years. In 1971, your dental insurance benefits were approximately $1000-$1200 per year. Some 40 years later, you will note that your benefits are still $1000-$1200 per year. Figuring a 3-5% rate of inflation per year, you should be receiving between $5000-8000 per year in dental benefits. Your premiums have increased, but your benefits have not. Therefore, dental insurance is never a pay-all; it is only an aid.
Myth #3: If there is a big difference between your fees and the amount the insurance company will pay, then your fees must be too high.
Fact: You may receive notification from your insurance company stating that dental fees are "higher than usual and customary". It is important to understand how they arrive at that figure. 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 high quality private practice will have fees that insurance companies define as higher than "usual and customary".
Myth #4: My insurance pays 100%
Fact: 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 up to the annual maximum. 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. The less your employer paid for the plan, the less you get
back.
Myth #1: My insurance reviews my dental claims and makes sure the correct treatment was done.
Fact: Claims are not read and reviewed by dentists. A “claims specialist” will review the claim, apply the plan provisions, and process the claim for payment. Your insurance company will pay for the most economical restoration that your plan allows for, rather than the best option for you. It is important to remember that reimbursement and benefit levels are based on what plan your employer has selected. The more money your employer pays the better the plan benefit. Dental insurance plans are a business arrangement between an insurance company and your employer. We have absolutely no influence on what they will cover and how much …show more content…
they reimburse.
Myth #2: If I have a good medical plan then my dental plan must be good too.
Fact: Dental insurance benefits differ greatly from general health insurance benefits. Medical benefits have gradually increased, while dental insurance benefits have been at a standstill for almost 40 years. In 1971, your dental insurance benefits were approximately $1000-$1200 per year. Some 40 years later, you will note that your benefits are still $1000-$1200 per year. Figuring a 3-5% rate of inflation per year, you should be receiving between $5000-8000 per year in dental benefits. Your premiums have increased, but your benefits have not. Therefore, dental insurance is never a pay-all; it is only an aid.
Myth #3: If there is a big difference between your fees and the amount the insurance company will pay, then your fees must be too high.
Fact: You may receive notification from your insurance company stating that dental fees are "higher than usual and customary". It is important to understand how they arrive at that figure. 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 high quality private practice will have fees that insurance companies define as higher than "usual and customary".
Myth #4: My insurance pays 100%
Fact: 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 up to the annual maximum. 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. The less your employer paid for the plan, the less you get
back.