Why doesn't my insurance company cover all the costs for my dental treatment?
Dental insurance isn't really insurance (defined as a payment to cover the cost of a loss) at all. It is a monetary benefit, typically provided by an employer, to help their employees pay for routine dental treatment. Most plans are only designed to cover only apportion of the cost.
But my plan says that my exams and other procedures are covered 100 percent.
That 100 percent is usually what the insurance carrier allows as payment toward a procedure, not what your dentist or any other dentist in your area may actually charge. The allowed payments are sometimes referred to as UCR or “usual and customary and reasonable” charges. However, UCR more typically represents a list of payment amounts negotiated between your employer and the insurance company. An employer usually selects a plan with a list of payments that corresponds to its desired premium cost per month. Therefore, there usually will be a portion not covered by your benefit plan.
If I always have to pay out-of-pocket, what good is my insurance?
Even a benefit that does not cover a large portion of the cost of what you need pays something. Any amount that reduces your out-of-pocket expense helps.
Why is there an annual maximum on what my insurance plan will pay?
Maximums limit what a carrier has to cover each year. Dental plans are different from medical plans, in that dentistry is needed frequently. Medical emergencies are rare. It is your dentist's responsibility to recommend what you need. It is the insurance carrier's job to control payments.
If my insurance won't pay for this treatment, why should I have it done?
It is a mistake to let benefits be your sole consideration when you make decisions about dental treatment. People who have lost their teeth often say that they would pay any amount of money to get then back. Your smile, facial attractiveness, ability to chew and enjoy food and general sense of well-being are dependent upon your teeth.
What should I do if my insurance doesn't pay for treatment I think should be covered?
Everyone at this office will do their best to maximize your reimbursement. As your periodontist, I do not have the power to make your plan pay. If your insurance doesn't pay, you are responsible for the total cost of treatment. Sometimes a plan will pay if patients send in claims for themselves, or if the Employee Benefits Coordinator where you work steps in. We will be happy to give you copies of what you need.
From: "My Insurance Covers This...Right?"
By Carol Tekovec, CDA, RDH
Her pamphlet is available by request