**Everything You’ve Ever Wanted to Know About Dental Insurance... But Were Afraid to Ask!**
Dental insurance differs significantly from medical insurance in several respects. Often, dental plans impose limitations such as waiting periods, frequency restrictions, maximum benefit caps, and various service exclusions—contrary to medical insurance, which typically lacks such constraints.
The accessibility of dental insurance emerged primarily in the late 1960s. In essence, dental insurance is not truly "insurance" in the conventional sense (a mechanism for covering losses); rather, it functions as a "monetary benefit" typically provided by employers to assist employees in managing routine dental care expenses. Employers usually select plans based on the benefit amount and monthly premium costs. Most dental benefit plans are designed to cover only a portion of the total treatment costs. When dental insurance was first introduced in the 1960s, the average annual maximum benefit per person was $1,000. Remarkably, this figure remains unchanged today. If dental benefits had kept pace with inflation, as medical insurance has, this amount would exceed $10,000 annually. It is essential to recognize that dental health holds equal importance to medical health; a $1,000 annual maximum in medical insurance would be inadequate for covering significant procedures like a broken arm or open-heart surgery. Our goal as dental professionals is to help you understand and maximize your benefits while achieving optimal dental health.
Comprehending your dental benefits can be challenging, as plans vary by employer and may change annually. Regardless of whether your plan covers a substantial portion of your dental expenses or only a minimal amount, dental insurance can significantly aid in facilitating your dental care. Unfortunately, limitations imposed by dental insurance companies should not dictate your decisions regarding treatment. It is crucial to remember that if you do not utilize your dental benefits within a given year, they will be forfeited, as they do not roll over. Preventative dental care is vital for your overall systemic health.
**What Are "Usual and Customary" or "Allowable Amounts"?**
The terms "Usual and Customary" (UC) or "Allowable Amount" refer to the predetermined dollar figures that insurance companies negotiate with your employer as the "allowed" payment for your treatment. This amount is often less—sometimes significantly so—than what local dentists may charge. From this "allowed" amount, insurers will pay a negotiated percentage for each procedure according to your employer's contract with the insurance provider. It is important to note that this does not imply that your dentist's fees are excessive.
For instance:
- Fee: $100
- UC or Allowable Amount: $90
- Percentage: 80%
- Insurance Payment: $72
- Your Copay: $28
**What Is a Deductible?**
A "deductible" is a predetermined amount that your employer has negotiated with the insurance company. Typically, it does not apply to preventive dental care, such as periodontal maintenance, oral cancer exams, and routine x-rays; however, specifics vary by plan. Deductibles generally apply to restorative dental treatments and oral surgeries and represent a one-time annual payment. Deductible requirements can differ significantly between companies, so it is advisable to contact your dental carrier for clarification on your particular plan.
A sample calculation for a dental deductible might look like this:
- Fee: $1,000
- UC: $890
- Deductible: $50
- Percentage: 50%
- Insurance Payment: $420
- Your Copay: $580
Calculation:
- $890 - $50 = $840 x 50% = $420
- $1,000 - $420 = $580
**Is Pre-Approval Required for Dental Treatment?**
No, while your dental insurance may suggest pre-determination, they cannot mandate pre-approval before treatment. Our office is prepared to collaborate with you and your insurance provider to provide the most accurate estimate possible, allowing you to make informed decisions regarding your dental care. Please be aware that we cannot guarantee the amount your dental insurance will contribute toward your treatment, as policies may change unexpectedly regarding maximum benefits, usual and customary allowances, deductibles, and plan limitations. While dental insurance can be very helpful, if your insurer does not pay as much as anticipated, you will ultimately be responsible for any incurred fees. Even with pre-approval, the exact payment cannot be determined until a claim is processed, which can sometimes be concerning. Therefore, we offer various financial options to ensure that dental care remains accessible and affordable.
**What Are My Payment Options If My Dental Treatment Exceeds My Insurance Coverage?**
At David J. Franz, DDS, we proudly offer several payment options. In addition to electronically filing your dental claims and pre-treatment estimates at no charge, we will assist you in selecting the plan that best suits your needs:
1. Deferred interest financing is available for 6 to 24 months through CareCredit for balances over $200, with low-interest financing options for extended terms available on a case-by-case basis.
2. We accept major credit cards, including Visa, Mastercard, Discover, and American Express, as well as ApplePay and GooglePay.
3. We also accept checks, health savings accounts, flexible spending accounts, debit cards, and cash.
Our administrative staff specializes in working with you and your dental insurance, ensuring you maximize your benefits each year.
We are honored that you have chosen our office for your dental care, and we are committed to helping you understand and fully utilize your dental insurance benefits.
Sincerely,
Your Dental Family at David J. Franz, DDS