Back in the old days, dental insurance used to be real simple. You got $1000 a year for dental benefits and once that was used up your benefits were gone. It didn’t matter what you had done and the dental insurance companies paid for it. Not so today. Today you have to fight tooth and nail for the dental benefits that you pay for. Just because you have a dental insurance plan doesn’t mean your dental procedures will be paid for. You must qualify for exactly what they cover in order for you to get the benefits you deserve.
Why do you have to fight so hard to get your dental services covered and what can you do about it?
- To answer the first question, somewhere along the line dental insurance companies figured out that if they could collect a premium from you for dental insurance plans and then deny your benefits they would make more money. So over the last 50 years, they have found interesting, innovative, and unique ways to disqualify your dental services from their plans. This boosts their profits and makes their stockholders happy.
- The answer to the second question is to arm yourself with some dental insurance facts that will help you be more knowledgeable about your dental insurance, so you can squeeze the maximum juice (and money) out of it each year. In other words, you have to play by the rules, but you have to know the rules.
Your dental insurance benefits are for you. You pay the premium and if you have dental needs, then you deserve to get them taken care of. So it is wise for you to arm yourself with dental insurance facts.
Below is a list of the top 10 dental insurance facts that will help you navigate through most dental insurance plans:
- Dental insurance facts number one: Each year you have a maximum amount of money that your insurance will pay for. This is usually $1000, $1500, or $2000. Good dental insurance companies have a $2000 annual maximum. Anything less than this is mediocre.
- Dental insurance facts number two: It is wise to use up your dental benefits each calendar year (January to December). If you have just a little work to do, try to get it all done in a calendar year, this way you only have to pay your yearly deductible one time. However, if you have a lot of dental work to do, use up all of your insurance each year. Why? Because, if you don’t use all your dental insurance each year, you will lose it. Many people pay premiums for years and never use their dental insurance. Their problems pile up and their dental insurance will only cover so much each year, so they sabotage themselves. Rather, do a little bit each year, nibbling away at your work, and then you won’t be surprised later.
- Dental insurance facts number three: good dental insurance plans cover 100% for preventative dental procedures like cleanings, X-rays, and fluoride treatments.
- Dental insurance facts number four: good dental insurance plans cover 80% for restorative dental treatments, such as fillings, root canals, gum treatments, and extractions.
- Dental insurance facts number five: good dental insurance companies cover 50% for crowns, bridges, implants and dentures.
- Dental insurance facts number six: good dental insurance companies cover 50% of orthodontic (braces) treatment up to $2500.
- Dental insurance facts number seven: good dental insurance companies do not have waiting periods for any of their services. Often times what looks like a good dental insurance is not good because the dental insurance company makes you wait 6, 12, or 24 months before you can have anything done.
- Dental insurance facts number eight: some dental insurance companies pay only for the cheapest materials. They downgrade the service your dentist provides to use a material that is cheaper. Good dental insurance companies do not downgrade services. For example, you may want a tooth-colored filling on your back tooth. Your insurance company will only pay for a silver filling. You may not want a silver filling but that’s all your insurance will pay for because your insurance company has a downgrade clause. You have to pay an “up charge” because of this. Here’s another example: You may want an implant, but your insurance company will only pay for a partial denture because it is cheaper. Look for dental insurance companies that do not have downgrade clauses. Nobody wants cheap stuff. I am sure the insurance executives don’t want cheap stuff in their mouths, why should you?
- Dental insurance facts number nine: good dental insurance companies allow you to go to your dentist. If you have to go to someone on their list, and there are only five names on that list, then it’s probably not very good dental insurance. Most traditional dental insurance plans or PPO dental insurance plans have hundreds of dentists that participate. Look for long lists.
- Dental insurance facts number ten: if you need a lot of dental work done, the best strategy is to figure out how much it’s going to cost you to get all of your dental work completed and figure out how many years it will take you to get it done. Here is the formula below:
Total Cost of Dental Treatment / Annual Maximum = Maximum years to complete dental care
For example: you need $6000 worth of dental work. Your insurance pays $1500 per year. $6000 divided by $1500 equals 4 years. So it will take you a maximum of 4 years to get your dental work completed if your dental insurance helps you pay for it.
The formula for the example above looks like this: $6000 / $1500 = 4 years to complete
Now, use ALL of your dental insurance each year to the maximum and then stop until the following year when you start up again and repeat this cycle. This is a good strategy provided you take great care of your teeth and your dentist starts with the worst teeth first and moves toward less damaged teeth later.
There you have it…10 Dental insurance facts to help make your life easier. Dental insurance companies aren’t bad. They are businesses and they are in business to make money. There is nothing wrong with that. You just have to remember that you are entitled to your benefits. As long as you follow the rules, you will receive them. We hope this article helps explain the rules a little better, so you can maximize the dental benefits that your family and you may need.
If you are unsure about any of your dental insurance benefits, please allow our team at Thomas L. Anderson, DDS and Associates to help any way we can… just give us a call. Dental insurance is continuously changing, and we want to see all our patients get the most out of their plans and their money!