dental insurance information

Dental Insurance: Points to Consider

The following is a plain-language synopsis of most dental insurance contracts. Please

read it carefully, and perhaps keep it for future reference.

• Dental insurance benefits do not work in the same way as medical insurance.

There is almost always a co-payment due from the patient for almost every

procedure.

• There are “deductibles” in all plans. At one time, these deductibles were never

taken out of preventive treatment (“cleanings”). Recently many carriers have

begun to take deductibles out of preventive treatment.

• Insurance companies do not typically provide seminars or instruction books on

the best method to obtain the highest financial reimbursement benefits for the

patient.

• Irrespective of any dental insurance benefits that might exist, the patient is always

legally responsible for the entire cost of dental treatment.

• The extent of dental coverage is solely dependent on the dental insurance plan

purchased by the employer. The higher the premium the employer pays, the

greater the dental insurance benefits.

• Even if there is a written predetermination of benefits returned from the insurance

carrier, it is possible that after treatment is provided, there are no insurance

benefits payable.

• We (the dental office) have absolutely no power or leverage to deal with the

insurance carrier. Only the employee or the contract purchases has power. Any

complaints about benefits, payment or coverage should be directed to Human

Resources or the company owner.

• The letters UCR on insurance vouchers stand for Usual, Customary, and

Reasonable fee. The dollar amount you see as UCR has no basis in reality. It is

an arbitrary amount determined solely by the plan selected and insurance

premium paid by the employee. There is no relationship to the actual dental

office fee. The better the plan (i.e., the more premium paid), the higher the UCR

will be.

• A single insurance carrier may have a dozen different UCR fees for the same

procedure, same office, and same dentist.

• There is no universal coverage and payment schedule established. Just because

an insurance code describing a dental service exists, it does not guarantee that it

will be a paid benefit under your policy. There are many dental procedures that

are necessary, and many of them are preventive, but are not covered benefits.

• Financial benefits cannot be saved and carried over into the next year.

Your dental benefits almost always have a yearly maximum contribution level. This

amount is the MOST your insurance carrier is contractually obligated to pay during a

defined year (calendar or otherwise). When this amount is reached, there will be no

further dental benefits payable until the next benefit year. If you have already begun

some additional dental treatment prior to the maximum being reached, the insurance

carrier has no payment obligation beyond that of the annual maximum.