Understanding Your Dental Insurance CoverageDental Insurance & Dental Coverage
I have dental insurance, why doesn’t it cover this?
All Dental Center in Watertown wants to help you better understand your insurance plan. Typically a dental benefit plan helps you pay for the cost of dental care. It is an arrangement between your employer and an insurance company. Contracts vary and knowing the limitations and benefits of your dental plan is important.
The object of a dental plan is to share in the cost of dental care. Often times the plan will not cover the total cost of what you are billed. Most dental plans cover between fifty and eighty percent of your total bill. Understanding benefits and reimbursement levels can be confusing. All Dental Center in Watertown designed this brochure to help our patients understand some of the confusing pieces of dental plans.
Usual, Customary & Reasonable (UCR) Plans
Under this plan patients can see any dentist they choose. The plan will pay a percentage of the amount charged by the dentist based on Usual and Customary fees. UCR rates are established based on the geographic area in which you live and a type of service provided to you.
When you receive the insurance statement you may note that the amount that your dentist has charged you is higher than the reimbursement of the UCR based fees of your plan. This means that the insurance plan will only pay the portion of the established UCR fee for the given procedure, and you will be responsible for the remaining cost.
Why Does It Work This Way?
Currently insurance companies are not regulated regarding the amount of money they reimburse and they are not required to explain what they do to determine amounts they reimburse. The way the policies are written vary widely and are inconsistent which makes the policies difficult for patients to understand.
Maximum Levels of Reimbursement
The company that purchases the dental plan is referred to as the ‘plan purchaser’ and they make the decision regarding what the maximum level of coverage or reimbursement will be. The cost of dental care has risen significantly over the years but the maximum levels of reimbursement have stayed the same for over fifty years. Plans that offer higher levels of coverage or increased amounts in the maximum level of reimbursements are more comparable to the true costs and better reflect todays advanced dental care costs.
Preferred Provider List
Some plans require choosing your dentist from a list the insurance company provides of preferred providers. If you do not choose a dentist from this list, it can affect the level of coverage and reimbursement you receive.
The least expensive alternative treatment (LEAT)
Most dental plans will provide benefits for the cheapest or least expensive alternative treatment.
In most cases dental insurance plans cover the cost of a composite filling up to the price of an amalgam filling. The patient will be responsible for the difference between the office charge for the composite resin filling and the amount paid by the insurance company for the comparable amalgam filling.
Here is an example: your dentist charges $200 for a composite filling. In this case the dental insurance company will only pay 80% of their $100 UCR fee for a comparable amalgam filling, which is $80. Patient will be responsible for the remaining 20% plus $100 (the difference in price between composite and amalgam filling).
The least expensive treatment option may not be the best option. Dentists will recommend what is best for the patient but patients need to decide what treatment they ultimately want to pay for.
If you had preexisting conditions before your dental plan was put into effect, there may be necessary treatments not covered by your dental insurance.
Many dental plans have exclusions regarding procedures and treatments they will not pay for. These treatments may still be necessary for optimal dental health and patients should prepare for these situations to occur.
Any questions or issues regarding your dental plan should be directed towards your employer or the insurance company that handles your dental plan. At All Dental Center, we would be happy to work with you answering questions regarding your dental plan. We can also look for levels of coverage for future procedures and predict what your costs may be.