Some of our patient have been asking more questions this year (2017) regarding their dental insurance since Obamacare (ACA) may or may not be repealed.
Here's 6 Facts regarding Dental Insurance:
Fact 1: No insurance plan is pay-all. It is only designed to aid in payment. Most have yearly maximums or deductibles.
Fact 2: Many insurance companies state they pay 40% to 100%. In spite of what is stated, most plans cover less than the average fee. The amount the plan pays is determined by the coverage purchased by the employer. The less paid for the coverage, the less the patient receives in benefits. This is usually very confusing for some patients.
Fact 3: Some insurance companies inform their subscribers that the doctor's "fees are above usual and customary fees," rather than saying "your benefits are low." Remember what you get in benefits is what your employer paid toward the plan less insurance company's profits and administrative costs. This is a basic business principal.
Fact 4: Unfortunately, some routine dental services are not covered by insurance plans. Always call your insurance plan to find out what is covered and what is not.
Fact 5: Generally, PPO's offer lists of participating doctors. This does not not always mean the list is up to date or mean that it is a requirement for the patient to choose a doctor from that list. You may still have the freedom of choice so call your insurance carrier.
Fact 6: Remember you have the right to see what doctor you want. Just because your insurance does not cover a procedure or does not pay to see a doctor out of network, it does not mean you can't get quality care.