Dental insurance is a benefit plan, unlike your medical insurance. Dental insurance is an agreement made between your employer and the insurance company to help pay for some of your dental needs. The more that your employer pays for coverage, the lower your out-of-pocket expense will be.
The services covered by the policy are totally arbitrary and have no relation to the treatment that you need or want. At Adult Dentistry of Rochester, Dr. Dulski's responsibility is to advise you what treatments are available and the risks and benefits of each. Your insurance contract is designed by lawyers and accountants to control costs for the insurer.
We can only estimate your insurance benefit prior to service. At Adult Dentistry of Rochester, we deal with thousands of plans and hundreds of types of treatment each year. Most insurance carriers refuse to release the details of their plans. They change policies and reimbursements constantly and without notice.
Occasionally, we are asked to send a written request to the insurance carrier for an estimate. This pre-authorization is rarely required, despite contract language that is designed to suggest otherwise. The process is so long and frustrating for patients that statistically nearly 70% of the planned treatment never gets done. Plus, carriers rarely disclose what the actual dollar amount of the reimbursement will be. Even after all that time and effort, the carrier is not obliged to honor the pre-authorization once treatment is completed. That's why Adult Dentistry of Rochester does not submit pre-authorizations. Honestly, if you can't afford the risk of the insurer not paying the estimated portion, then you can't yet afford to proceed with the planned treatment.
We are happy to process your paperwork for you. To accept insurance, we ask you to keep a credit card on file. Before treatment, we will approximate your coverage and ask for your estimated co-payment. After insurance pays, we will credit or charge your card to reconcile the difference. Whether your insurer pays some, all, or none of the estimated coverage, remember that you are ultimately responsible for payment. To learn the financial options that are available at Adult Dentistry of Rochester to pay for your dental needs, visit http://www.dulski.com/affordable.html.
Tags: Dental Insurance, Payment Plans
Before selecting or changing a dental plan, there are some important things to consider. Some plans require patients to choose a dentist from a limited list of dentists.
ReplyDeleteDental plans are typically business arrangements between an insurance company and an employer. Most plans are designed to pay only a portion of your dental expenses. However, dental plans may exclude or discourage certain treatments, such as dental sealants, which can prevent tooth decay and save you money later on. Carefully read a plan and know its limitations. If a plan doesn't cover a procedure that is recommended by your dentist, this does not mean that the treatment isn't appropriate or needed.
Some plans do not cover pre-existing conditions, such as missing teeth. Others may not cover dental implants, specialist referrals and other dental needs. Even when you and your dentist agree on the appropriate treatment method for your condition, the contract provision of the dental plan may only pay a portion, or pay only for the least expensive alternative treatment (LEAT) as determined by the insurance company.
So make sue you know what your plan covers before you choose that one.
Every day untold numbers of dental patients are upset because their dental insurance plan did not pay a greater portion of their dental bill. More often than not, when told their insurance will pay 80 percent, it ends up paying less than 40 percent. Subscribers are persuaded into believing this is because their dentist charged too much. In other words, the dentist gets the blame.
ReplyDeleteFew realize that employers, and not the insurance companies, determine what is paid for. Most will provide dental benefits to their employees, but only at a minimum cost. With overhead costs skyrocketing, dental plans have become "tailor-made" to deliver increasingly limited benefits to employees. The best example of this is the benefit amount an insurer pays toward eligible charges during a 12-month period. This is called the "yearly benefit."
Read more: Is dental insurance worth all the pain? | Minneapolis / St. Paul Business Journal
Our office has a love/hate relationship with dental insurance companies. It is nice that patients have some help with their dental expenses. However, the problems associated with this benefit can be time consuming, frustrating too.
ReplyDeleteThe biggest problem with insurance and their payment schedules is that often imply either directly, or indirectly that their insured's dental coverage is excellent and should cover all of their needs. If these expectations are not met, it is assumed by the patient that the dentist's fees are too high. This sets us up to be the "bad guy" by having to explain the reality of the situation.