Dental Insurance has been a wonderful thing for many people.  It has provided patients with the incentive to have their mouths cared for on a regular basis.  Often though, patients are disappointed in their benefits because of misunderstandings regarding their policy.  In order to help readers better understand dental insurance policies and their annual benefits, I thought it would be good to share some facts about dental indemnity insurance today.

Dental insurance first became available in the early 1960’s.  At that time many policies had a maximum annual benefit of $1000 that would be provided for the patient.  This was an excellent benefit for an employee because a great deal could be done in restoring a patient’s mouth to good health.  Unfortunately, 40+ years later in 2004, the maximum annual benefit on a large percentage of dental policies is still $1000.  Some have increased benefits to $1500, but even this improvement hasn’t kept pace with inflation.  Interesting isn’t it!  Here are some of the facts you should consider:

Fact #1      Many dental offices file the pertinent claim information to the various dental insurance companies as a courtesy to the patient.  Patients should understand that dental insurance is a contract between the patient, the employer and the insurance company.  The dentist is not a party in the contract and has no say over the benefits that are paid or what procedures are covered.

Fact #2       Dental insurance is not meant to cover all fees.  It is meant to be an aid to the patient’s investment in their own health.  Not all necessary procedures are covered by dental policies as well.  

Fact #3       Many insurance carriers claim to reimburse the insured person “up to 80% or up to 100%” of the total fees.  In actuality, most dentists have found the plans cover 40-60% of average fees.  Some plans reimburse more, some less.  But, the amount of benefit reimbursed for a procedure is determined by the amount of premium that has been paid for the policy.  Different policies pay different amounts on the exact same procedure.

Fact #4       Usual, Customary or Reasonable Fees, (UCR) a term used by the insurance company is an arbitrary amount which an insurance company chooses to pay for each procedure.  It is not based on the average charge of practicing dentists in the area.  It is merely the “allowable” amount they will reimburse for a given procedure.

Fact #5       Insurance companies will not release the exact amount they will pay for a procedure until the treatment is completed and the claim is submitted.  They will only state the percentage of their fee schedule that they will cover.

Dental insurance is an excellent benefit that has given many people the opportunity for good oral health.  Regrettably, there are a lot of misunderstandings about insurance policies that could be avoided.  Most dental offices will make every effort to assure the patient receives the maximum benefits for any treatment needed, but if restorative care is extensive, it won’t be a “cure all”.  Please don’t hesitate to ask questions about your policy.  Both your employer and dentist want you to be fully informed.