Dental insurance is a necessity today, but it can be very confusing to the average person. It is further complicated because every insurance plan covers different services, and sometimes requires different paperwork. That's because a dental insurance plan is a contract between you and your provider. This makes it vitally important for you to thoroughly read your insurance policy and speak with your representative, making sure that you understand exactly what is covered and how your plan pays for your dental treatment.
Although most dental insurance plans only cover basic services, we believe it is important to choose the dental treatment plan that is most appropriate for you and your loved ones.
The first question to ask your insurance representative is whether or not you are free to choose your family's dentist, or do you have to choose one who belongs to the plan's network.
As for how they determine payment for dental treatment, there are several methods commonly used. One is called the Table of Allowances in which the insurance provider lists the treatments it will pay for and the amount it pays for each treatment or service.
Another prevalent means of determining payment is the UCR (Usual, customary, and reasonable) method. With this method the dental insurance provider calculates a maximum amount for a particular treatment that it deems usual, customary, and reasonable and then pays for 50 - 80% of that amount. You then pay the remaining 20-50% UCR fees, plus the difference between the actual cost of treatment and the plan's UCR fees.
Most people reasonably assume that insurance agencies which publish a Table of Allowances or UCR fees have accumulated a data table of statistics as to what amounts are currently charged by dentists, reflecting current office, equipment, and treatment costs. However, while statistics may be gathered, insurance companies are not required to use them, and there is no requirement for them to maintain accurate and up-to-date statistics. This means, of course, that most insurance plans' UCR fees are usually not representative of what your local dentists actually charge.
To further complicate matters, different dental plans within a single company often base their fees on a different set of UCR fees for the exact same geographical area and for the very same group of dentists. It is even common for a single insurance company to pay different UCR fees to the same dental office, depending upon which of the company's plans the individual is enrolled.
The choice is yours!
Needless to say, most dental insurance companies have kept up with neither the advances in technology, nor the rising costs of maintaining a safe and hygienic clinic and well-trained staff. Many plans only cover minimum quality materials and services, excluding treatments they label as discretionary. These often include such common treatments as implants, white fillings, bonding, fluoride treatments, and some periodontal care.
Dental coverage maximums have not kept up with the times either. In 1960, a typical annual maximum benefit was $1000. In today's market, many plans continue to offer that same $1000 maximum even though inflation alone has caused that annual maximum to rise to more than $6500.
All of these factors combine to make many patients choose a treatment plan that their dental insurance plan does not fully pay for. We urge you to choose the best plan for you and your loved ones dental health.
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