Why Doesn’t My Insurance Pay for This? A Four Part Series on Insurance Coverage

The blog is back with a four part series.  The ADA has a great informational pamphlet that I was reviewing with our newer team, Austin Braham, our Schedule Coordinator and dental novice until now!  In reviewing it with him it inspired me for another blog series deconstructing the mystique of insurance coverage.


Having dental insurance or a dental benefit plan can make getting the dental care you need easier but do not cover all the expenses incurred in the dental office for a good portion of people.  Many people with the same insurance company see vastly different coverage because it is based on the options the employer chose and the plan they ultimately decided to fund.  As your dental office seeking to provide you with the best possible care we urge you to decide on treatment because of necessity, not dental coverage.


So how do these plans work?  Almost all dental insurance plans are a contractor between your employer and the insurance company.  These two parties agree on the amount your plan pays and what procedures are covered.  You may think that you have 100% coverage but in all reality your employer has chosen a plan that pays 100% coverage up to a certain amount, which is usually about half the going rate now a days.  Our main goal at your dental office is take care of your teeth and make the recommendations we see most fit for your current oral health.  To help with that we file insurance on your behalf as a service to you and research your insurance as best as possible before your appointment to understand the ins and outs of your coverage more than what is written on paper when you get your coverage breakdown.  There are so many questions we can ask to get a closer estimate of what your insurance will cover but when the explanation of benefits comes to you in the mail, the portion of the bill for the procedures done in office not covered by your insurance is the patient responsibility.


I think we would see more of an understanding of the patient responsibility if we reviewed some of the cost-control measures that are taken by your dental benefits plan to keep costs low on their end but as a result, push fees back on to you as the patient.


Next week we will define UCR, Annual Maximums and treatment by different kinds of Providers.