The availability and utilization of dental insurance is growing rapidly but remains confusing to most consumers. It is important to remember that insurance companies are “for” profit” businesses. The design of the dental coverage, including benefits, exclusions, deductibles, co-pay and annual maximum coverage allowable, is crafted to ensure that the total annual premiums paid into the insurance company will exceed the total amount of benefits paid out to insured dental patients in every calendar year. The way dental insurance works often places the participating dentist and staff in the difficult position of having to deliver what seems like dental coverage to the patient because the employer insurance company has either done an inadequate job of accurately explaining the dental coverage or exaggerated the benefits to the employee. These are the failures that give rise to the many problems and misunderstandings of dental insurance. Far more Americans have medical insurance than dental insurance. Medical insurance and dental insurance are vastly different in form, function and coverage.
Medical insurance is designed primarily to cover the costs of diagnosing, treating and curing serious illnesses. This process may involve a primary care physician and multiple specialists. It may require a variety of tests performed by doctors and laboratories, multiple procedures and masses of medications. Depending on the health, age and attitudes of people in the medical coverage group, costs can fluctuate widely.
Dental insurance works differently. Most dental coverage is designed to emphasize preventive care. The applicable x-rays, a thorough prophylaxis, and examination by the dentist are required to diagnose dental conditions. Usually, dental care is provided by a general practitioner, although in some cases may require the services of a dental specialist.
Dental benefit plans are structured to encourage patients to get the regular, routine care so vital to preventing and diagnosing the onset of serious dental disease. While not understood by most patients, nearly all dental benefit plans require patients to assume a greater portion of the costs for treatment of dental disease than for preventive procedures. Many dental insurance plans are not very generous when it comes to paying for major dental treatment with most covering less than 50 percent of the cost of major treatment. Most plans limit the benefits–both in number of procedures and dollar amount–that are covered in a given year.
Because each person’s oral health is different, costs can vary widely. To restrict dental treatment costs, most insurance plans will limit the amount of care you can receive in a given year. This is done by placing a dollar “cap” or limit on the amount of benefits you can receive in a calendar year, or by restricting the number of type of services that are covered. For example, it is not unusual for a dental insurance plan to limit its total payments for each insured patient in any calendar year to $1000. In some dental insurance plans, this annual limit can be as low as $500 but it is rarely higher than $1500. Some plans may totally exclude certain services or treatment to lower costs.
The insured dental patient should know specifically what services his/her plan covers and/or excludes. This should include, but not limited to, deductibles, co-payments, exclusions, and the annual maximum limitation. These categories will vary widely throughout the hundreds of dental insurance companies operating in today’s market place.
Our office has years of expertise and experience with dental insurance. Once the treatment plan that is best suited to the patient has been established, the friendly administrative team at Dr’s Johnson and Liebhart will help each insured patient understand his/her coverage and how to best maximize the benefits due to the patient.