Dental Insurance or Dental Benefit – Part 3

Posted: July 20, 2011 in Dentist
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Have you ever received a notification from your insurance company stating that dental fees are “higher than usual and customary”, rather than saying their dental benefits are too low?  An insurance company surveys a geographic area, calculates an average fee, takes 80% of that fee and considers it customary.  Unfortunately included in the figuring of that fee are DMO (the dental equivalent of the HMO), discount dental clinics and managed care facilities.  These practices will bring down the fee that is considered UCR (Usual and Customary Rate).  Any doctor in a high quality private practice will have fees that insurance companies define as higher than “usual and customary”.

The dental insurance company is NOT going to lose money on any deal when it negotiates fees with dentists.  You, the consumer make up the difference.  How?

There is a dental insurance company out there that will not pay the fee for white fillings to the dentist.  They base the payment that will be going to the dentist on amalgam “silver” fillings.  The 50-100% of the fee they will pay is based on the much lower amalgam fee, but you, the patient, must make up the difference between the silver filling fee and the resin “white” filling fee.  52% of all dentists no longer place amalgams, and most people do not want the unsightly silver in their mouth.  It is tough when you pay for dental benefits, but the insurance company has dictated that they will only pay for a silver filling.  (This insurance company I am talking about sent us a letter stating all posterior “back” teeth will be paid as amalgams and all posterior crowns will be paid as base metal crowns.  Even if the employer wanted to pay extra for the white fillings and the noble metal crowns).

Know your dental benefits.  As time goes on, they will decline.  At Aristo Dental we are here to help you decipher your benefits.

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