What is fact and fiction with dental insurance?

            It can be very challenging to navigate all the nuances of dental insurance. With so many carriers and different plans within those carriers, it can be overwhelming. Below we discuss a few of the facts and fictions involving dental insurance that you should know.

Fiction: Insurance companies pay the fees that a dental office charges.

Fact: It has been our experience that some insurance companies tell their customers that “fees are above the usual customary rate.” We believe that the “insurance benefits are low.” The reality is that you get back only what your employer, puts in minus the profits of the insurance company. We aren’t saying insurance companies aren’t entitled to some profit, but it should be known what their methods are.

Fiction: The new plans that are offered are basically the same as the plans that have always been available.

Fact: The new plans are referred to as PPO’s or DMO’s. They are simply discount plans. These plans require the dental office to discount their fees nearly 50%. If an office chooses to take these plans and take care of daily overhead, the dentist must choose less expensive or faster options for treatment. This increases the chance that the treatment may not provide the same long term results as when an office is not restricted by the insurance company.

Fiction: Once you hit your annual deductible, the rest of the treatment is free.

Fact: Dental insurance doesn’t work the same as medical insurance. It is more comparable to a coupon or discount. It rarely pays for the entire service and the percentage it will pay is vague and open to interpretation by the insurance company. The big difference from medical: once you have reached your yearly maximum, it no longer pays on anything.

Fiction: My insurance pays for any work I need to have done.

Fact: Not all recommend procedures will always be covered by your insurance. When your employer selects a dental plan, it is decided which procedures may or may not be included. The lack of coverage by your insurance company does not mean it is not needed.  It just means the chosen plan does not cover the recommended procedure.

            This can be very confusing and frustrating. If you have any questions or concerns on which dental plan may be best for you and your family, feel free to contact us and we can hopefully help you in deciding which one is best for you.

Lee T. Brown, DDS

Brown and Kupper DDS, Inc.

www.dentistwestchester.com.