The advent of dental plans several decades ago, has made it easier for millions of patients to receive dental work, and today most medium and large employers have dental plans included in their employer benefits.
The combination of dental plans with an increased public awareness and demand for modern dentistry as dramatically improved the dental health of Americans across the country.
It is important to understand that every plan is different and some may reimburse at 80%, others at 90%, while a few may reimburse at 100%. Worth noting is the fact that if you have a plan that reimburses 100% of 1996 dental fees for example (because it was conceived in 1996 but never updated) you will not receive 100% of your claim in 1998.
Furthermore your plan may have different coverage for different procedures. For example is a plan that covers 80% of fillings and extractions, but 50% of major treatments such as crowns and bridges.
Such coverage is still quite satisfactory, and encourages the patient to be involved financially, which generates a greater sense of appreciation and value for the dental care received.
If your treatment will be extensive, your dentist will be pleased to provide the insurance with an estimate (pre-
determination), to confirm your actual cost and reimbursement, thereby enabling you to plan your finances before starting with treatment.
Most plans have limits per calender- year which means that what you do not use at the end of the year cannot be carried over to the next year. Therefore be wise with the accounting aspect of your plan, and use what you are entitled to before the year-end.
Unfortunately there are always plans which are minimal and restrict the patient's choice of dentist and/or treatment. These plans insist that the patient attend a particular dentist(s) and restrict coverage and reimbursements.
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Please remember that the dentist's responsibility is to diagnose the condition of your mouth, your dental needs and to offer a treatment plan that will best suit your needs, not the insurance.
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These types of plans are not recommended and I strongly encourage you to know your dental plan, in order to eliminate disappointments.
It is important to note that all plans are contracts between your employer, yourself and the insurance company. Your dentist does not participate in these negotiations, and may not know the details of the numerous plans available.
The dentist's only obligation is to provide the patient with a detailed claim form after the treatment is rendered, describing the work done and the fees charged. The patient then sends the claim form to the insurance company for reimbursement.
You and your dentist may choose to have the insurance pay him/her directly (called assignment), but this arrangement still leaves you responsible for the entire balance, since most dental plans do not pay 100% of your dentistry.
If you need help understanding your particular plan call your insurance company using their 800 telephone numbers. Should you need more information your dentist will certainly be more than happy to help you.
Please remember that the dentist's responsibility is to diagnose the condition of your mouth, your dental needs and to offer a treatment plan that will best suit your needs, not the insurance.
