Understanding your Dental Insurance

Over the years, I have heard it all when it comes to insurance. From “my insurance pays 100%”, to “I’m not sure what my insurance is.” The thing that I have learned is that many of these plans are not properly explained, if at all, to the employee and/or subscriber at the time they are purchased. Not only does this leave patients with questions, it also creates extra work for our office to provide the patients with the most current and up to date coverage under their plan. For a long time, dental insurance was nothing more than an add on to the medical coverage. Unfortunately, even though this is not the case any more, the coverage for most of these plans has remained unchanged in the last 40 years. The best time to find out all you can about your insurance is either during the open enrollment period with your employer, or if you are self-insured, while the representative is there to sell the plan, ask as many questions as you can. Ultimately, your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract.

As a courtesy to our patients, our office does contact the dental insurance carrier. We receive a summary of benefits, but only the information the insurance is willing to reveal. With this information, we are able to give our patients a close approximation of what they can expect to pay out of pocket. This does not let the patient off the hook though. Patients need to be well versed and pay attention to the explanation of benefits that the insurance company provides. Some situations require documentation from the patient and a claim can be held up if the patient is unaware of it, such as primary and secondary information, divorce decrees, and student status.

During the beginning of each year employers search for new, less expensive plans and therefore may change plans. Patients need to be aware of any changes in their plan and be prepared to provide this to our office. I don’t know how many January’s I’ve spent sorting through plans because the patients didn’t know their employer changed plans, or were given very little information about the new plan including a new dental card. This will unnecessarily delay a claim. If we cannot receive payment from the insurance company, the balance of all work that was completed then becomes the responsibility of the patient.

Being an active participant in your plan not only benefits you, but it also helps our office do what we do best and that is to give our patients the best dental care around!

-Lisa Karau

the Levine Dental Team