Thoughts on Dental Insurance

Hello Friends!

Have you ever wondered how dental insurance works? I know that sounds ridiculous, I mean, who sits around thinking about dental insurance, right? But if you understood how that process works, it may save you from unpleasant surprises if a dental need came up.
Back in the “good ole’ days”, many people had insurance; medical, dental, vision, provided by their employer, that covered just about anything – with very little cost (if anything) paid out of pocket. Then, suddenly, benefits started dwindling away – being cut dramatically or entirely. This forced people to have to pay attention to their policies. As dental professionals, we are educating patients daily about their individual policies. Here are the basics:
Most dental insurance policies have a “maximum” allowance for a calendar year. Typically between $800.00 and $2000.00. per person on a policy. For most patients, this covers basic cleanings and minor, basic restorations. For more extensive needs, say a root canal and a crown, benefits can be exhausted quickly, causing the patient to pay the remainder “out of pocket”.
Once maximums are considered, co pays, deductibles and percentages are factored in. A typical dental policy may have a $50.00 deductible that applies to anything more than a cleaning. That means the patients pays the first $50.00 of a procedure, then the insurance company will pay a percentage of the remainder. What percentage you ask? It depends on the policy. Again, an average policy may cover 100% of “preventive services” ie: cleanings, exams and maybe x-rays. “Basic Services” (typically fillings) may be covered at 50% – 80%, then “Major Services” (root canals, crowns, extractions) may be covered at say 40% – 50%. Sometimes, insurance companies “downgrade” services, meaning they will only pay a percentage of the fee that they feel is acceptable, leaving the remainder to be paid by the patient. The dentist has no say in this whatsoever, being at he mercy of the dental company. Oral surgery and Orthodontics may have a separate allotment – again, it depends on the individual policy.
Does your policy state that you need a “PPO” provider? Some policies state that you must go “in-network”. This means that the insurance company will pay a “participating provider” (the dentist) a lower fee for services.
Have your eyes glazed over yet? It can certainly be mind-numbing to think about insurance, but it is really important to understand your individual policy should you need treatment. Your insurance agent is a good place to start if you have questions. The front staff at your dental office should also be able to educate you to the basics of your individual policy.
Thinking about dental care and insurance isn’t fun and can often be overwhelming. Knowing about your options ahead of time may at least soften the blow.
If you have any dental or insurance questions, give us a call 734.878.8167, or visit our website at www.brunnerfamilydental.com. We would be happy to help. If you are in the Pinckney area, and are looking for a great dentist, stop by and say hello. We’d love to meet you and show you what makes our office so special.