Is Your Insurance Expiring?
September 27, 2012
I don’t know how you feel but I think this year is just flying by. I guess I feel like that every year. Only three more months left in 2012. For those of you with dental insurance, only three more months to use your dental benefits before they disappear and go toward the bonuses for the insurance executives. That is kind of a joke and it is kind of not.
As you know, if you have dental insurance, you have a yearly maximum amount of money that can be used for dental care. Although that yearly maximum (typically $1000-1500 per year) has not changed for 40 years in most situations, if you don’t use the money the insurance company keeps it. That’s right, if your insurance company doesn’t write a check out for your dental care, they keep whatever you don’t use.
On that note, if you have dental work that needs to be done, now is the time to do it. The only catch is that because many patients wait until the end of the year to use their dental insurance benefits, it is often difficult to get an appointment. Therefore, those reading this column will be one step ahead of everyone else. The big rush generally occurs in the next couple of weeks so book your appointments now.
This is especially true for patients who need multiple things done. Let me use a specific example. Let’s say your dentist has told you that you need a crown on a tooth but the tooth will need work done by a periodontist or even the dreaded root canal prior to doing the crown. Getting the “pre-crown” work done at the end of this year will allow you to finish the crown in the beginning of next year and maximize your insurance benefits.
It has always seemed crazy to me that we have to play these games with dental insurance, but that’s the way it works. If you have been told that you needed some work done and haven’t done it, call your dental office or insurance carrier to see what remaining benefits you have.
Just for clarification, as this is an area that patients sometimes get confused on, your yearly maximum is yours and not your spouse’s. If you and your spouse have dental insurance and a $1000 yearly benefit, you get to use $1000 and your spouse gets to use $1000. If you go over your maximum you cannot use any of your spouse’s benefits.
For those without dental insurance – you are not missing out on too much. Yes, dental insurance is nice to have, especially if your employer is paying most or all of the premiums. However, people tend to get into the frame of mind that if they do not have dental insurance they can’t go to the dentist.
I had a patient in just yesterday that had not been in for 5 years because he said he did not have insurance. Five years later the patient needs more work done than the insurance benefits will cover. It’s not worth it.
One thing is for certain, regardless of whether you have insurance or not, regular visits to a dentist is the key. If your goal is health you can’t do it alone. If the cost, or the fact you don’t have dental insurance is what is holding you back, talk with an office that offers financial arrangements that work for you. The longer you stay away the more difficult it is to catch up.
Have a great autumn. Beat the rush and schedule those appointments.
But I Have Insurance
February 11, 2011
I had a reader e-mail me an insurance related question this past week and wanted answer that question as well as a couple of other insurance related issues.
Patients will sometimes balk at treatment not covered by their dental insurance. Dentists will often hear, “Just do what my insurance covers. I don’t want anything extra.” In fact, a recent ADA poll showed that a lack of dental insurance was the No. 1 reason most patients gave for not visiting a dentist. So, here are some frequent questions patients often ask about dental insurance.
Why doesn’t my insurance cover all of the costs for my dental treatment?
Dental insurance isn’t really insurance (defined as a payment to cover the cost of a loss) at all. It is a monetary benefit, typically provided by an employer, to help their employees pay for routine dental treatment. “Dental Insurance” is only designed to cover a portion of the total cost.
But my plan says that my exams and other procedures are covered at 100%.
That 100 percent is usually what the insurance carrier allows as payment towards a procedure, not what your dentist may actually charge. Dentist’s fees are usually a reflection of the level and quality of care in a particular office. Some cost more, some cost less, depending on the costs of running their office, how much they pay their staff, the materials they use, etc. An employer usually selects a plan with a list of payments that corresponds to its desired premium cost per month. Therefore, there usually will be a portion not covered by your benefit plan.
If I always have to pay out-of-pocket, what good is my insurance?
Even a benefit that does not cover a large portion of the cost of what you need pay something. Any amount that reduces your out-of-pocket expense helps.
Why is there an annual maximum on what my plan will pay?
Although most maximum amounts have not changed in 30 years, a maximum limit is your insurance carrier’s way of controlling payments. Dental plans are different from medical plans, in that dentistry is needed frequently. Medical emergencies are rare. It is your dentist’s responsibility to recommend what you need.
If my insurance won’t pay for this treatment, why should I have it done?
It is a mistake to let your benefits be your sole consideration when you make decisions about dental treatment. People who have lost their teeth often say that they would pay any amount of money to get them back. Your smile, facial attractiveness, ability to chew and enjoy food, and general sense of well-being are dependent on your teeth.
Other than complaining to your dental insurance company or your Employee Benefits Coordinator, your best defense is to budget for dental care, or ask your dental office if they have payment plans to spread payment out over time.
If you have any other insurance related questions please e-mail them to me.
Do Just What My Insurance Covers
November 19, 2010
Patients will sometimes balk at treatment not covered by their dental insurance. Dentists will often hear, “Just do what my insurance covers. I don’t want anything extra.” In fact, a recent ADA poll showed that a lack of dental insurance was the No. 1 reason most patients gave for not visiting a dentist. So, here are some frequent questions patients often ask about dental insurance.
Why doesn’t my insurance cover all of the costs for my dental treatment?
Dental insurance isn’t really insurance (defined as a payment to cover the cost of a loss) at all. It is a monetary benefit, typically provided by an employer, to help their employees pay for routine dental treatment. “Dental Insurance” is only designed to cover a portion of the total cost.
But my plan says that my exams and other procedures are covered at 100%.
That 100 percent is usually what the insurance carrier allows as payment towards a procedure, not what your dentist may actually charge. Dentist’s fees are usually a reflection of the level and quality of care in a particular office. Some cost more, some cost less, depending on the costs of running their office, how much they pay their staff, the materials they use, etc. An employer usually selects a plan with a list of payments that corresponds to its desired premium cost per month. Therefore, there usually will be a portion not covered by your benefit plan.
If I always have to pay out-of-pocket, what good is my insurance?
Even a benefit that does not cover a large portion of the cost of what you need pay something. Any amount that reduces your out-of-pocket expense helps.
Why is there an annual maximum on what my plan will pay?
Although most maximum amounts have not changed in 30 years, a maximum limit is your insurance carrier’s way of controlling payments. Dental plans are different from medical plans, in that dentistry is needed frequently. Medical emergencies are rare. It is you dentist’s responsibility to recommend what you need.
If my insurance won’t pay for this treatment, why should I have it done?
It is a mistake to let your benefits be your sole consideration when you make decisions about dental treatment. People who have lost their teeth often say that they would pay any amount of money to get them back. Your smile, facial attractiveness, ability to chew and enjoy food, and general sense of well-being are dependent on your teeth.
Other than complaining to your dental insurance company or your Employee Benefits Coordinator, your best defense is to budget for dental care, or ask your dental office if they have payment plans to spread payment out over time.
