FACTS YOU SHOULD KNOW ABOUT DENTAL INSURANCE
FACT #1 Your dental insurance is based upon a contract made between your employer and an insurance company. Should questions arise regarding your dental insurance benefits, it is best you contact your employer or your insurance company directly.
FACT #2 Dental insurance benefits differ greatly from general health insurance benefits. In 1971, your dental benefits were approximately $1000.00 per year. Some 4 decades later, you will note that your benefits are still $1000.00 per year. Figuring a 6% rate of inflation per year, you should be receiving approximately $5000.00 per year in dental benefits. Your premiums have increased, but your benefits and insurance fee schedules have not. Therefore, dental insurance is never a pay-all; it is only an aid.
FACT #3 You may receive notification from your insurance company stating that dental fees are “higher than usual and customary”. 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. The fee for service doctors in private practice will have these fees that insurance companies define as higher than “usual & customary”.
FACT #4 Many plans tell their participants that they are covered “up to 80% or up to 100%” but clearly do not specify plan fee schedule allowance, annual maximum or limitations. Remember, the amount a plan pays is determined by how much your employer paid for the plan. After all, insurance companies are profitable businesses not dental benefactors. You get back only what your employer agreed to less the profits of the insurance company.
FACT #5 Many routine dental services are NOT covered by insurance companies.
If you would like to know your out-of-pocket expense, a pre-determination can be submitted to your insurance company.