A person should always be well acquainted with their insurance plan, however we know that dental insurance can be a tricky thing to navigate! You can always reach out to you insurance company for assistance, but here are some quick dental facts that will help you as an insured patient better understand your policy.
Fact 1- NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. Unfortunately, this is not true. Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company.
Fact 2- BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary or reasonable fee (UCR) used by the company. A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most dentists in the area charge for a certain service. This can be very misleading and is not accurate.
Fact 3- INSURANCE COMPANIES SET THEIR OWN SCHEDULES
Insurance companies set their own schedules, and each company uses a different set of fees they consider “allowable”. These allowable fees vary widely, because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR fee. Frequently, this data can be three to five years old and these “allowable” fees are set by the insurance company, so they can make a net profit of 20%-30%. Unfortunately, insurance companies imply that dentists are “overcharging”, rather than say that they are “underpaying”, or that their benefits are low. In general, a less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.
Fact 4- DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, one must consider deductibles and percentages. If you are unsure about any of your benefits or the expected deductible and co-pay at your appointment, don’t hesitate to give our office a call at (608)781-3999 to talk with one of our staff members. The front desk staff is highly experienced in dental insurance and will be able to answer any questions you may have. We understand that dental insurance can be confusing, but we are here to help you anytime!
This article was written by Valley Dental