Posts Tagged ‘dental benefits’

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.

Met Life, Delta Dental, Aetna, Cigna and Guardian Insurance companies all provide some type of dental “insurance” that employers or individuals can choose from along with their general health insurance benefits.  The dental “insurance” benefits differ quite a bit from the general health insurance benefits.  Let’s compare the two.

When you go to your medical doctor for your yearly exam, you may have a co-pay.  Let’s say for instance that you have been diagnosed with high blood pressure.  Your doctor will give you a prescription for medication and would like to see you again in two weeks.  You go to check-put and you pay your co-pay of $25.  As the weeks go by, your blood pressure is not regulated to where the doctor wants it to be, but each time you go in, you must pay the $25 co-pay.  The insurance covers the doctor visits, no matter how many you may need to get the blood pressure under control.  (This is true if your policy states this with no limitations.)  They may be paying the doctor $1000’s of dollars.  The limit on health insurance is in the millions of dollars for most policies.

When you go to your dentist for your preventive care appointment, you may have a co-pay, but most likely you do not.  Let’s now say that you have been diagnosed with periodontal disease.  Your dentist and hygienist have recommended you come back more frequently for hygiene visits.  Scaling and root planing are recommended along with every 3 month perio-maintenance procedures.  The dental “insurance” will cover up to $1000 in benefits.  THAT IS IT!  Even though periodontal disease has been linked to heart disease, patients with diabetes have been recommended to see the dentist at least 4 times per year, and children with braces should see the hygienist at least 4 times per year, the dental benefits only allows $1000/year and only two exams and two “healthy” cleanings.

When dental insurance benefits first started in 1971, the benefits were approximately $1000 per year.  40 years later, you will note that more than 75% of the benefits are still $1000 per year.  Do you know of anything that you bought in 1971 that would be the same cost today?  When you take a 6% rate of inflation per year, you should be receiving over $5000 per year in dental benefits in today’s market.  Have your premiums remained the same since 1971 for the same benefits?

Dental insurance is not a pay-all; it is only a benefit.  It is not insurance – it is a benefit with a yearly maximum.

At Aristo Dental, we have found a way to help people who run out of benefits and those who do not have dental benefits provided by their employer.

“I only want to have done what my dental insurance will cover”

“If my dental insurance doesn’t cover it, I really don’t need it”

“My dental insurance covers 100%”

These are some of the comments that we hear from patients on a daily basis here at Aristo Dental.  Our Practice Administrator, Sharan Tash has had 15 years of experience dealing with insurance companies, patient benefits, and successfully explaining the two to the patients.  Lack of education is the most important part of the miscommunication between employers, the employee, the insurance benefits and the dental office.  We hope to answer some of the most commonly misunderstood facts in regard to dental benefits in a series of posts.   (I use the term dental benefits instead of dental insurance because most people think of dental insurance just like medical insurance – it is unlimited.  The term benefit changes their perspective.)

1.  Dental benefits are provided and chosen by the employer.  An employer will look at many policies from many companies, including Met Life, Guardian, Delta Delta and United Health Care.  Each of these insurance companies have individual policies for each employer, therefore Met Life’s payable benefits for Company A will be different than Met Life’s payable benefits for Company B.  The employer has several choices in benefits to provide to their employees that will save money.

  • “Cleanings” once every 6 months instead of twice per year any time of year will save the employer money
  • Paying for the placement of  silver fillings on back teeth instead of white fillings will save the employer money
  • Paying for base metal crowns on back teeth instead of high-noble metal will save the employer money
  • Having a 10 year replacement of crowns instead of a 5 year replacement will save the employer money
  • No covering dental implants will save the employer money
  • Incorporating a missing tooth clause will save the employer money
  • Not paying for oral cancer screening will save the employer money
  • Not paying for adult fluoride treatment will save the employer money

At Aristo Dental we diagnose according to what is best for the patient’s health – NOT what is best for the insurance benefits.  We also have all patients sign a treatment consent showing their approximate insurance benefit BEFORE work is done so we can explain those benefits and their financial investment in their work.

We look forward to presenting more educational material on your dental benefits in future posts.