Dental
Insurance
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Q. How did I reach my annual maximum so quickly? A. Dental benefits differ greatly from medical benefits. In 1959, most dental benefit plans had a yearly maximum cap of $1,000. You'll be surprised to know today that the average dental benefit plan still has a yearly maximum cap of $1,000. There has been no significant increase in the yearly maximum cap in 40 years!. However, there have been significant increases in your premiums as well as the cost of dental care by providers. Dental benefit plans will never pay for your complete and comprehensive dental care. It is only meant to assist you. Q. I thought my insurance covered 100% of cleanings? A. Many dental benefit plans tell their participants that they will be covered "up to 80% or 100%" but do not clearly specify the plan fee schedule allowance, annual maximum or limitations. It is more realistic to expect dental benefit plans to cover between 25% to 40% of dental services. Remember that the amount a plan reimburses is determined by how much your employer has paid for your dental benefit plan. you will get back only what your employer has put in, less the insurance company's profit margin. Q. What is "above usual and customary"? A. An insurance company determines their reimbursement level by surveying a geographical area, calculating the average fee, then determines that 80% of the average fee is customary. Included in this survey are discount dental clinics and managed care facilities. Any doctor in private practice will have fees that insurance companies define as "higher than usual and customary." Q. Will my insurance cover sealants? A. More and more insurance companies are covering sealants, however, many also limit the age of the patient and type of teeth that they will pay for. Many companies will only cover dependent children to the early teens and will only pay for unrestored permanent molars. Be sure to read your policy regarding sealants. |
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60 Union Street @ Pearl Sidney, NY 13838 (607)-563-2333 |