At Artisan Dental Center, we realize that most dental “insurance” plans are sadly inadequate to cover most needed dental treatment to any great degree. We have found that most dental patients are unaware of exactly how dental “insurance” works and how it benefits them. Below you will learn just how dental “insurance” works and how to get the maximum benefit from your particular plan.
WHAT IS "DENTAL
INSURANCE"?
Some patients are surprised to learn that dental insurance is actually not insurance at all! Dental insurance is a contract between your employer and a dental benefits company. Your employer has purchased a benefits plan contract sold to him by the dental benefits company. The benefits that you will receive are based on the terms of the contract that were negotiated between your employer and the dental benefits company and not your dental office. The goal of most dental "insurance" policies is to provide only basic care for specific dental services. The services selected are based on the cost of the policy to your employer and the negotiated arrangements with the dental insurance company.
Understanding this, it is easy to see that every dollar the insurance company pays to a participating dentist for dental services rendered to a covered patient is overhead to them. Can you understand why they want to pay out as little as possible??
WHY DOES THE INSURANCE COMPANY ONLY PAY FOR CERTAIN PROCEDURES?
Remember, the insurance company wants to make a lot of money! This is why cleanings, X-Rays, examinations, and basic care are covered very well in most plans. However, when it comes time for fillings, replacement of missing teeth, or surgical treatment, most patient find these services are only covered partially or not at all! The selection of non-covered services is not based on what you need or want, but is based strictly on the contract with the insurance company.
WHY DID THE INSURANCE COMPANY DENY MY CLAIM?
Another tactic used by insurance companies is denying or delaying valid claims. This allows them to keep money in their investments for longer periods of time, thus making them more profit. This is what is referred to as the “float”.
You can combat this tactic by having your dentist write a “narrative” form clarifying the nature of the denied treatment AND complaining to the Human Resources (HR) department at your workplace.
I NEED A LOT OF WORK AND THE INSURANCE COMPANY WILL ONLY COVER A SMALL AMOUNT OF IT. WHY??
A sobering fact that most dental patients do not realize is that each dental insurance plan has a dollar amount limitation each year (your yearly "maximum"). Once this limit is reached, no other services will be covered by your dental insurance company regardless how essential the service may be to your dental health.
When I began my dental practice more than twenty-five years ago, the average insurance company had a yearly maximum benefit of $1000.00. Guess what it is today?? You are right - $1000.00!! What a disgrace!!
This is exactly what the “insurance” companies want, as the more confusion regarding patient benefits and what is covered, the less the patient will utilize their plan. This maximizes profits for the insurance company.
IS MY DENTAL INSURANCE WORTH HAVING??
This is very easy to determine!! Just visit the Human Resources person where you work and ask him or her how much is subtracted from your paycheck every month for your plan. Then ask what your yearly maximum benefit is per year.
Take the monthly amount you are charged and multiply by twelve. This is how much per year your “insurance” costs you. Subtract this amount from your yearly plan maximum. The result is the real value of your dental plan. Not as much as you thought, Eh??
Many of our patients have dumped their plans after doing this little exercise - perhaps you will too!
