The first of the year is always a busy and amazing time! A fresh start, new resolutions, and for some of our dental patients, it means NEW INSURANCE BENEFITS!! How exciting! Everyone loves new Dental Insurance benefits. Dr. Ross, a Loveland Dentist, would like to share some insight on how Dental Insurance is different than Health Insurance. Insurance in general can get confusing. There are always so many different options, copays, in-network, out-of-network, PPO, and time frames which procedures or claims must be performed within.
Medical Insurance operates a lot differently than Dental Insurance does. Medical Insurance is actual insurance that you, your employer, or the state pays a premium for. After your deductible has been met, your insurance will then cover hospital costs without a limit. For example if you broke your arm, you would pay your deductible, and then your insurance pays the rest. If you’re having a really bad year and break that same arm again, your insurance would pay again. Also with medical insurance, if you are just really down on your luck this year and have another additional health scare like cancer, your insurance would pay for that treatment since your deductible has already been met.
Dental Insurance is a contract. Sometimes it is a private contract between you and the company, but most of the time it is between your employer and the Insurance Company. Your employer picks the plan they think is the best that the Dental Insurance Company has to offer. It does not match each person’s needs, but rather, it’s a generic contract, sort of like “one size fits all”. But we all know that one size does not always fit everyone perfectly. Everyone has different needs and desires. Dental Insurance is not insurance like Medical Insurance; it’s more like a free coupon. So much money has been put into the plan, and once the money has been used up, the plan will no longer cover anything else. Once your deductible has been met, the plan will pay a percentage of the procedure you require. The percentage amount always varies because the company may not agree with what the cost of the treatment should be. Dental companies have not changed their maximum in years, yet the price of Dentistry has gone up like so many other things, due to the rising cost of supplies. For example: Let’s say you bite down and break your tooth which now needs a filling. You want the tooth colored filling (Composite) rather than the silver filling (Alloy) because even though the broken tooth is in the back of your mouth, it is still visible in your smile line. You pay your deductible and your Dental Insurance is supposed to pay 80% of the cost, but since you choose tooth colored on a back tooth, they only pay 80% of the silver fee, and the tooth colored costs more. You are now obligated by your contract to pay the remainder of the balance. Later in the year, peanut brittle looks really tasty and you bite down and the same tooth breaks again. Darn! That same tooth needs another filling. You have another filling placed and pay your portion, and since the last time this happened, you know you’ll have a little bit more out of pocket due, so you take care of the whole thing. A month later the insurance comes back and denies the whole procedure, because you already had a filling on that tooth this year, and they will only pay for a filling on a tooth once every two years per the terms of your contract. Now you are left with the whole balance. This year has just been one of those years! You fall on some ice and hit your front tooth causing it to break. Double darn! It’s really painful, and now you need a root canal and crown. You proceed with the root canal, you pay the portion your contract says will be due, and now you need a crown to make this tooth stable, plus Dr. Ross will make it look beautiful just like the rest of your teeth. But, your contract amount has reached its limit so the crown will not be covered this year. You have a waiting period for all “major restorative”. What options do you have? According to your Insurance contract, you have to wait a full year from the time the contract was signed. Now the whole crown must be paid for out of pocket.
Dental Insurance really isn’t an insurance per say. We always appreciate anything that helps, like coupons, but when it comes to our health, Dr. Ross never advises anyone to base their health on a coupon. Here at Ross Family Dentistry in Loveland, we treat everyone as an individual and always encourage our patients to do what is best for them.
And as always, if you’re confused or have questions, please just ask. We’re here for you!