I have dental insurance, now what?
One of the most useful and yet confusing benefits that patients have is dental insurance. It does not work exactly like health insurance and the benefit can be quite confusing.
Blue Cross began dental insurance in the 1960's as an added benefit. The average coverage back then was $1,000 per year. Does this number look familiar? As more employers began providing it, over the years, dental insurance has morphed into many different plans.
Costs have certainly gone up since the 1960's, why is maximum coverage still the same?
Insurance companies rely on the fact that only 50 percent of the population go to the dentist regularly. When these plans were first introduced, the likelihood of every member maximizing the usage of the insurance was very low. Costs of care have risen over the years and insurance utilization has increased accordingly. As utilization increased, dental insurance companies basically held the benefit the same wile increasing he cost of the premium in order to control costs.
What is UCR?
UCR stands for usual and customary rate.This is a term that is used to determine how much a dental insurance company will pay for a procedure in a given zip code. How UCR determined is a secret that insurance companies will not share. Typically dentists set their UCR fees based on their fixed (rent, utilities, etc ), and variable costs (supplies, lab) for a procedure.
Why is UCR so confusing
Dental insurance companies may offer several plans in the same state to the same employer. These plans are chosen based on what the employer can afford to pay. The more the employer pays for a dental plan, the better the coverage for the user. The problem with UCR is that insurance companies use different UCR tables for different insurance plans. This is confusing for patients.
How does dental insurance work?
Dental insurance works basically like regular health insurance, so there's no real mystery or confusion there. It's very similar to basic health insurance in that it's covered by HMO and PPO plans or payment structures. Occasionally, you may find an indemnity dental insurance plan, which allows for the ultimate freedom in choosing dentists and procedures, but these are becoming rare in this day and age.
Understanding a dental HMO and PPO is the same as understanding a regular health insurance structure. An HMO plan you pick will require you, as the patient, to choose either a single dentist or a dentist group to handle your dental care. After you select the dentist and/or facilities, all procedures deemed usual by the insurance company and performed per your plan will be covered. With a PPO plan, you will have the option of being able to select dentists from around your immediate area, so you're not locked in with only one option
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Why is UCR so confusing
Dental insurance companies may offer several plans in the same state to the same employer. These plans are chosen based on what the employer can afford to pay. The more the employer pays for a dental plan, the better the coverage for the user. The problem with UCR is that insurance companies use different UCR tables for different insurance plans. This is confusing for patients.
How does dental insurance work?
Dental insurance works basically like regular health insurance, so there's no real mystery or confusion there. It's very similar to basic health insurance in that it's covered by HMO and PPO plans or payment structures. Occasionally, you may find an indemnity dental insurance plan, which allows for the ultimate freedom in choosing dentists and procedures, but these are becoming rare in this day and age.
Understanding a dental HMO and PPO is the same as understanding a regular health insurance structure. An HMO plan you pick will require you, as the patient, to choose either a single dentist or a dentist group to handle your dental care. After you select the dentist and/or facilities, all procedures deemed usual by the insurance company and performed per your plan will be covered. With a PPO plan, you will have the option of being able to select dentists from around your immediate area, so you're not locked in with only one option
What is covered?
This can vary widely from plan to plan.
This can vary widely from plan to plan.
Coverage for a typical Indemnity plan would be something like this:
- $100 per person deductible
- $1,000-$1,500 per year maximum coverage
- preventive services (exam, x-rays, cleanings) paid at 80-100% of the insurance company's UCR
- basic services ( fillings, extractions) are paid at 70-90% of the insurance company's UCR
- Major services (considered most expensive like crowns, bridges, root canals, dentures) is typically included but paid at 40-50 percent of the insurance company's UCR
- Many procedures that are considered cosmetic (veneers, witening, bonding, braces) may net be covered at all.
- the patient pays for fees over the amount covered
PPO, HMO and other plans like these may have set fee schedules for the dentist who has signed up for them. The patient portion is variable and determined by the insurance plan. The plan may have a similar annual maximum benefit.
We can help you with your dental insurance.
We have team members who specialize in helping you understand your coverage. As a courtesy, we will file your claim for you and work hard to make sure you have the highest possible coverage for every procedure.
Dr. Neal answers all of your questions about Dental Insurance at Crystal Lake Dental Associates.
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