Ask Dr. Bill - Dental Insurance
July 28, 2016 at 4:25 p.m.
By Bill Stofer-
Tom, Warsaw.
Tom, dental insurance benefits are not a black and white area. You are not alone in your confusion about their complexity, and the poor information available about dental insurance coverage.
Most dental patients find that it is almost impossible to properly understand the benefits provided under their dental insurance plan.
The coverage of your dental insurance has nothing to do with your dentist; it is a contract between your employer and the dental insurance company. Your employer has chosen your dental insurance.
The coverage and the treatment options that were selected by your employer were based on the cost of the policy and provide only basic care for specific dental services. Unfortunately for you, the services your dentist provided must not have been totally covered, or may not be even covered at all, by your employer provided dental plan.
Another reason for your dentist’s bill may be because you may have exceeded the yearly dollar amount limitation. Once you exceed the amount agreed upon by your employer and the insurance company, regardless of how essential the service may be to your health, the additional service will not be covered and is your responsibility.
This little known fact to patients and to their dental provider is another reason there is so much confusion about dental insurance. In addition to knowing what is covered, and how much has been paid to each patient, you should be aware that most insurance plans do not cover 100 percent of any dental fee and in many instances they cover less than 50 percent, or even none of the necessary services your dentist provided. So another reason for your bill could be that the service wasn’t covered or was only partially covered by your employer provided insurance plan.
The objective of most dentists is to provide the best quality dental care and to quickly and efficiently alleviate any dental discomfort that the patient may be experiencing.
This is not the objective of your dental insurance company.
Their objective is to only provide the benefits for the agreed upon services that were negotiated between their company and your employer.
The reimbursement is based on a mathematical formula and what percentage will be covered for each service.
I’m sure that your dentist does not want to provide sloppy service or insufficient treatment based on restraints placed on you by an insurance company. Dental insurance companies often make their profits by paying for the cheapest alternative treatment, regardless of what is in the best interest of the patient. These substandard dental treatments are often as good as no treatments at all.
Another possible reason for your bill may be that your dental insurance company has attempted to control the amount and type of dentistry you receive by requiring advanced authorization for treatments. Normally, we begin treatment for your discomfort before receiving the authorization from your insurance company. Isn’t that the way most patients would want it?
In the event that the company refuses to pay all or part of the treatment fee, the patient is responsible for the balances.
Most dental providers furnish their patients with the full cost of the service in advance so any cost isn’t a complete surprise.
However, dealing with an insurance company can be a lengthy, time-consuming process and there may be a long period of time between your treatment, the adjusted payment, and the time you are billed for the balances.
You should be aware and most dental offices will provide information about the services that are not covered by dental insurance companies. If not, ask the personnel department at work to explain it to you.
These include any cosmetic procedures, implants, orthodontic redesigns and other services that may have been negotiated by your employer. Yes, these important dental services greatly enhance the quality of life of dental patients, but insurance companies don’t feel they should pay for them. Dental offices normally let their patients know if their treatments will cross that line between pay and no pay.
Tom, I hope I have answered your questions about those costs not completely covered by your employer provided dental insurance plan. Dental insurance continues to become more complicated every day as the insurance companies attempt to reduce costs by changing coverage to improve their bottom lines and increase their stock price at the expense of the patients.
Most dental providers will do everything possible to help you understand your insurance benefits and will provide full assistance to you so you receive the maximum amount of benefits due. Our office completes and submits the forms electronically and follows up when the payments seem to be slow in coming. If you have additional questions, feel free to contact us for as additional information about your situation and your insurance.
Dr. Bill Stofer is a practicing dentist in Warsaw and is a member of the Academy of General Dentistry, American Dental Association, Indiana Dental Association, and the North Central Dental Society. He is a lifelong resident of the Warsaw area, a graduate of Warsaw Community High School, Hillsdale College, and the Indiana University School of Dentistry.
Do you have a question about this article or about any of your dental concerns for Dr. Bill? He can be reached at 574-269-1199. All questions will be answered and considered for future columns. Visit us online at www.dentalsolutions.net[[In-content Ad]]
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Tom, Warsaw.
Tom, dental insurance benefits are not a black and white area. You are not alone in your confusion about their complexity, and the poor information available about dental insurance coverage.
Most dental patients find that it is almost impossible to properly understand the benefits provided under their dental insurance plan.
The coverage of your dental insurance has nothing to do with your dentist; it is a contract between your employer and the dental insurance company. Your employer has chosen your dental insurance.
The coverage and the treatment options that were selected by your employer were based on the cost of the policy and provide only basic care for specific dental services. Unfortunately for you, the services your dentist provided must not have been totally covered, or may not be even covered at all, by your employer provided dental plan.
Another reason for your dentist’s bill may be because you may have exceeded the yearly dollar amount limitation. Once you exceed the amount agreed upon by your employer and the insurance company, regardless of how essential the service may be to your health, the additional service will not be covered and is your responsibility.
This little known fact to patients and to their dental provider is another reason there is so much confusion about dental insurance. In addition to knowing what is covered, and how much has been paid to each patient, you should be aware that most insurance plans do not cover 100 percent of any dental fee and in many instances they cover less than 50 percent, or even none of the necessary services your dentist provided. So another reason for your bill could be that the service wasn’t covered or was only partially covered by your employer provided insurance plan.
The objective of most dentists is to provide the best quality dental care and to quickly and efficiently alleviate any dental discomfort that the patient may be experiencing.
This is not the objective of your dental insurance company.
Their objective is to only provide the benefits for the agreed upon services that were negotiated between their company and your employer.
The reimbursement is based on a mathematical formula and what percentage will be covered for each service.
I’m sure that your dentist does not want to provide sloppy service or insufficient treatment based on restraints placed on you by an insurance company. Dental insurance companies often make their profits by paying for the cheapest alternative treatment, regardless of what is in the best interest of the patient. These substandard dental treatments are often as good as no treatments at all.
Another possible reason for your bill may be that your dental insurance company has attempted to control the amount and type of dentistry you receive by requiring advanced authorization for treatments. Normally, we begin treatment for your discomfort before receiving the authorization from your insurance company. Isn’t that the way most patients would want it?
In the event that the company refuses to pay all or part of the treatment fee, the patient is responsible for the balances.
Most dental providers furnish their patients with the full cost of the service in advance so any cost isn’t a complete surprise.
However, dealing with an insurance company can be a lengthy, time-consuming process and there may be a long period of time between your treatment, the adjusted payment, and the time you are billed for the balances.
You should be aware and most dental offices will provide information about the services that are not covered by dental insurance companies. If not, ask the personnel department at work to explain it to you.
These include any cosmetic procedures, implants, orthodontic redesigns and other services that may have been negotiated by your employer. Yes, these important dental services greatly enhance the quality of life of dental patients, but insurance companies don’t feel they should pay for them. Dental offices normally let their patients know if their treatments will cross that line between pay and no pay.
Tom, I hope I have answered your questions about those costs not completely covered by your employer provided dental insurance plan. Dental insurance continues to become more complicated every day as the insurance companies attempt to reduce costs by changing coverage to improve their bottom lines and increase their stock price at the expense of the patients.
Most dental providers will do everything possible to help you understand your insurance benefits and will provide full assistance to you so you receive the maximum amount of benefits due. Our office completes and submits the forms electronically and follows up when the payments seem to be slow in coming. If you have additional questions, feel free to contact us for as additional information about your situation and your insurance.
Dr. Bill Stofer is a practicing dentist in Warsaw and is a member of the Academy of General Dentistry, American Dental Association, Indiana Dental Association, and the North Central Dental Society. He is a lifelong resident of the Warsaw area, a graduate of Warsaw Community High School, Hillsdale College, and the Indiana University School of Dentistry.
Do you have a question about this article or about any of your dental concerns for Dr. Bill? He can be reached at 574-269-1199. All questions will be answered and considered for future columns. Visit us online at www.dentalsolutions.net[[In-content Ad]]
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