At Sharma Oral Surgery we believe our patients deserve the best possible care we can provide. With this in mind, we wanted to share some facts about dental insurance with you.
- Your dental insurance is based upon a contract that has been negotiated between your employer and the insurance company. Monthly premiums will be related to what benefits are covered; to keep monthly premiums at a minimum and to save their costs your employer may opt-out of covering certain treatments. Should questions arise regarding your dental insurance benefits, (ex: what is covered and why) it is best for you to contact your employer or the insurance company directly.
- Dental Insurance benefits, with yearly maximums basically unchanged since the 1960s, differ greatly from traditional medical health insurance. If dental benefits reflected inflation yearly benefits could be as high as $28,000 today. It may be easier to understand dental insurance by relating it to air miles earned when a credit card is used, your premiums ‘earn’ your benefits. There will be some blackout days, treatments not covered, and even if you have enough ‘miles’ to get your treatment, you will always have something to pay out of pocket. Once you have used all your ‘miles’ you will have to pay completely out of pocket.
- Insurance companies send notices out stating that the dental fees you were charged are ‘higher than usual and customary.’ Although insurance companies never reveal how ‘usual, customary and reasonable’ (UCR) fees are determined, it is understood that they collect the ‘average’ fee for a particular procedure in a geographic area. Average has been defined as the ‘worst of the best’ and the ‘best of the worst,’ by that definition we are proud to say that Dr Sharma is not average and we at Sharma Oral Surgery do not offer average service to our patients.
- When a plan states the insurance company will pay up to 80% or even 100% of a covered benefit, they are basing it on their fee schedule, UCR, annual maximums or limitations. Unfortunately, it is not often that 100% actually equates to 100% in the eyes of the insurance company. The percentages and amounts paid are determined between the insurance company and your employer.
- Some dental services are not a paid benefit, generally to keep premiums low; either because they were negotiated out by your employer, or it is a limited individual plan that restricts who you can see and what treatment will be paid for. This DOES NOT mean that the treatment is not necessary or appropriate.
We feel that dental insurance can be a great benefit for many patients and want you to know we will do everything in our power to ensure that you get every benefit dollar you are entitled to. However, the treatment we recommend and the fees we charge will always be based on your individual need, not your insurance coverage. The ultimate decision as to what will be done and how fast we proceed will always be made by you. Based on your decision, we will discuss the total cost of treatment and what assistance you can expect from your dental insurance.
