The Dental Insurance Puzzle

Do you ever wonder why you receive a bill from the dentist even though you have dental insurance and paid your co pay? Well I used to till I became a dentist myself and was enlightened to the whole world of dental insurance. Let me clarify that dental insurance is a completely different animal from medical insurance. Some medical insurances will cover particular types of dental treatment like jaw surgeries, wisdom teeth extractions etc; but in general you cannot go to a dental office with medical insurance and expect to be covered for dental work. Dental care has separate insurance plans. Why is it so difficult to understand dental insurance? Dental insurance is a very complex area creating confusion for many people. The lack of sufficient information provided by some dentists and some insurance companies makes it almost impossible for patients to properly understand their benefits. Dental insurance is typically a contract between your employer (this could be you if you’re self-employed) and a dental insurance company. The benefits that you receive are based on the terms of the contract that were negotiated between your employer and the dental insurance company and not your dental office. The goal of most dental insurance policies is to provide only basic care for specific dental services. What if you need some particular type of dental treatment according to your dentist and your insurance company does not cover it? Unfortunately dental insurance companies don’t look at what a person needs but go by what has been negotiated between them and your employer. Here’s an example. If a patient has a small cavity, I would do a white filling also called a tooth colored filling rather than a silver filling, because less tooth structure needs to be drilled, it’s a bonded filling giving a better seal, looks better, usually does not need any anesthetic injections making it painless, and I believe it’s a better restoration in the long run. For a silver filling the tooth has to be drilled more as it needs a certain depth even if your cavity is not that deep running the risk of making your tooth sensitive. Also silver fillings look ugly when you open your mouth. So given the choice I would do only tooth colored fillings as far as possible. It’s the better treatment for the patient. When most insurance companies say they cover 80% of fillings it’s usually the silver filling and you will have to pay your 20% plus the difference between the cost of the silver and white filling. That’s where the confusion typically arises when you get your dental bill. Also what’s the difference between a deductible and a co-pay? These are two separate entities. A deductible is a one-time fee that you pay each year to your insurance company. It’s collected at your dentist’s office but it goes to the insurance company. You can think of it as an annual fee charged by the insurance company for processing your claims etc. A co pay is a payment you make to the dentist as a part of the payment for a particular treatment. A co pay will vary depending on what you had done. It varies according to the percentage your insurance will pay for that treatment. Say if your insurance pays 60% for root canals your co pay will be 40% of the amount you need to pay for the root canal. A dentist participating in an insurance plan is bound by his contract with the insurance company to collect any co pays that they state he or she should collect. At Rane’s Dental Offices, our treatment coordinators make sure that insurance and finances are discussed with you before we do any treatment so we can avoid shocking you with that dental bill. Please feel free to call us at 609 275-1777 if you still have dental insurance questions and we will try to get answers for you, promise!!

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