Dr. Stone's Office

Dental Insurance Myths - Part 2

November 7, 2016
Posted By: Walter Raby, MBA, RDA
Insurance definition in a dictionary

Now that we understand the difference between dental plans and insurance, here is the second half of the dental insurance myths blog:

2.I Can’t see the Dentist Without Insurance

Several times we have phone calls to cancel an appointment as they can’t go to the dentist without dental coverage.  In fact, in most cases it is probably cheaper to see the dentist for your routine visits, as you are saving on the premiums that you would have paid for dental coverage. Please also see our membership plan on the “finance” page: http://www.northernhillsdentist.com/Financial-Info. Even if you have a dental plan, most Americans do not budget enough for their dental costs per year.  Dentistry is not expensive, but neglect is. 

3.The Plan Covers 100%

Many times, I hear from several patients that their dental plan states that they cover 100% of their dental visit.  What is dangerous about this position is that there are factors that affect this level of coverage. 

  1. Is the dentist “in-network” with the dental plan?

If “yes” it is likely that the plan will cover 100%; however, there may be a limitation for the frequency of procedures.

  1. Is the dentist “out-of-network” with the dental plan?

If “yes”, the plan will pay 100% of their approved figure; any difference will be the patient’s copay.

  1. Have you used up all of your benefits for the year?

If “yes”, then your dental plan has reached the full amount of what they will pay in a year regardless of the percentage they say that they cover.             

4.No Limitations

In order to prevent profit loss, dental benefit companies will limit the frequency/amount of procedures in a given category; giving a false sense of coverage.  On average, you can only have a dental crown (per tooth) every 5 years, cleanings twice a year, exams twice a year, and x-rays annually.

5.Pretreatment Estimate is  a Guarantee

When pre-treatment or pre-determinations are sent to dental plans, it is not a guarantee of payment.  I have received two of these back recently.  On one, it states at the bottom: “We will make final determination of eligibility and benefits upon receipt of this claim for final payment”. On the other it states: “Receipt of this pre-treatment request may not guarantee payment.  Actual benefits will be determined when the services are completed and submitted for payment.   We can provide this same information without the delay in your treatment.

6.I Haven’t Used my Plan – I have Built Up a Lot of Benefits

Unfortunately, if you don’t use your plan benefits, you lose it.  Dental plans love it when they keep your premiums and benefits. They count on those who do not use their plan benefits to pay for those who do use their policy.

7.We know your insurance and all of the changes that have happened

Patients come in for an appointment without knowing what their insurance covers.  I’ve had some expect that the dental plan contacted our office with any policy changes or if there were changes to a different company.  If we have seen you in the past, chances are that we have checked on your insurance benefits and may find out if a policy terminated.  However, we don’t know if you have a new policy, if you changed to a different carrier, etc. We do not have a database where we can look up everyone’s insurance information and have it tell us all of the changes. If something changed in your dental plan coverage, chances are we won’t know until you tell us.  We will try to catch the times when we know the dental policy on file is no longer available for use.

Please feel free to give our office a call for an appointment. Dental health is very important and you are fortunate to have a plan that helps pay for your visit.  We are in-network with Delta Dental and we submit claims to all of the other dental plans.   

Contact us via the Internet: http://www.northernhillsdentist.com/Contact-Us-Schedule-Appointment or call us at (605) 584-2983 for an appointment today!

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