5 facts you should know about dental insurance coverage

Many patients have questions concerning their insurance coverage. Because we believe patients deserve the best service possible, we would like to share some interesting facts concerning insurance coverage.

We hope these facts help clarify some of the information your patients are receiving.

FACT 1: No insurance plan is pay-all. It is only designed to aid in payment. Most have yearly maximums or deductibles.

FACT 2: Many insurance companies state they pay 80% to 100%. In spite of what is stated, most plans cover less than the average fee. The amount the plan pays is determined by the coverage purchased by the employer. The less paid for the coverage, the less the patient receives in benefits. This is usually very confusing for patients.

FACT 3: Some insurance companies inform their subscribers that the doctor’s “fees are above usual and customary fees,” rather than saying “your benefits are low.” Remember, your patient gets back in benefits what his or her employer paid toward the plan less the insurance company’s profits and administrative costs.  This is a basic business principal.

FACT 4: Unfortunately, some routine dental services are not covered by insurance plans. Always try to inform your patients prior to treatment if you are aware of a service, which is not a covered expense. Inform before you perform.

FACT 5: Generally, the PPOs and HMOs offer lists of participating doctors. This does not always mean that it is a requirement for the patients to choose a doctor from that list. Patients may still have the freedom of choice. Strive to be your patients’ practice of choice.

The filing of insurance claims is a service provided for your patients. Every effort should be made to maximize your patients’ benefits. Insurance plans are a wonderful supplement for your patients, but they must be made aware of the hidden truths about insurance coverage.

By providing information for your patients regarding insurance coverage, misunderstandings can be avoided prior to beginning treatment. The goal of providing quality dentistry for extremely satisfied patients can be achieved by not allowing insurance companies to dictate treatment because of plan benefits. 

We must always remain insurance aware, not insurance driven.