Most Dental Insurance Plans Don't Work Like Other Insurance
If you're under the assumption that dental insurance will 100 percent cover any type of treatment or work that you need to have done, in most cases you'd be incorrect. That's because most dental insurance plans work more like "discount coupons" than anything else. For example, while a dental plan may cover routine cleanings and annual X-rays, it may not completely cover the cost to fill any cavities, leaving you with a bill that you have to pay out of pocket. Other plans may cover cavities and other treatments, but with a co-pay.
The bottom line is that dental plans usually work much differently than other types of insurance. In fact, in some circumstances, dental insurance may not even be worth it (this is mostly true if your employer doesn't offer any type of coverage and you opt to acquire a plan yourself). With that being said, here's a look at some of the common misconceptions and limitations of a typical dental insurance plan:
In some cases, benefits are limited to what an insurer deems to be an appropriate cost for dental services. These are known as "usual, customary and reasonable," or USR, fees. However, the actual cost for many of these services is much higher than what the insurer deems reasonable, which can thereby lead to out of pocket costs for service.
Dental treatment is usually broken into three classes, ranging from routine to serious, and thereby often dictating the amount of coverage. Class I is routine dental care, and is almost always covered 100 percent by a dental plan. Class II consists of more complicated procedures, like fillings and extractions, and offers coverage, but usually only to a certain extent. Class III are sophisticated, major procedures and most plans offer even less coverage for such. Hence, the discounted coupon model applies, as say a filling may be covered up to 70 percent while a root canal may only be covered up to 40 percent.
Under most circumstances, cosmetic treatment is not covered in any way by your dental insurance plan, meaning that all fees associated must be paid out of pocket. That's because in most cases, cosmetic dentistry is not considered "medically necessary," thereby meaning it is not covered by insurance plans.
Since dental insurance operates differently than other types of insurance, it is needless to say that deciphering what is and is not covered can be confusing. That's why it's important to find a dentist that not only accepts the type of insurance that you have, but can also explain it to you in a way that's easy to understand. This allows you to get a better grasp of what you'll be responsible for should your insurance not cover a particular service or services.
Here at Caven Dental, we pride ourselves in working with patients to help them understand the confusing world of dental insurance. For more information or to schedule an appointment or consultation, contact Caven Dental today.
June 01, 2015 | by Richard Caven