If you ventured an outing at Chuck E Cheese’s recently, you may have observed the loss of the vintage novelty that is the manifestation of merriment itself: The Token. Yes, that cup of tarnished mouse engraved coins has been substituted for a plastic card, and like similar cards, it comes with a false sense of security as the freedom of continual swiping comes to an abrupt halt without warning or discretion. This experience is all too analogous with your dental insurance card, as well. Understanding your dental insurance benefits and how to manage them can help avoid any undesired surprises.
The first thing to know about dental insurance is that the common association of protection that comes with insurance is a concept that is simply immaterial today. As opposed to working as a safeguard against unexpected calamity or unforeseen expenses, dental insurance, now, acts more as a discount coupon for routine services and the occasional necessary treatment. According to one expert, “If car insurance were designed like a dental plan, an oil change and tune-up would be covered at 100%; shocks, tires, and batteries would be reimbursed at 80%; and accidents would be reimbursed at 50%, with an annual maximum limit of $1,000.”
Most dental insurances provide a maximum payout, typically between $1000 and $2000, that is used towards all or a percentage of various dental treatments after a small deductible is met, depending on the plan’s coverage. Some routine treatment like cleanings and x-rays are covered at 100% and may not require a deductible, but other treatment is categorized by your insurance and coverage is variable from 50% to 80% or not at all. For in-network dentists, the dentist has an agreement with the insurance provider to adhere to negotiated fees. The dentist is obligated not only to adhere to these fees, but to collect any copays associated with them. This is to avoid any discrimination between patients under the same plan. Only if an office is out-of-network or if a service is not covered by the insurance plan can the fee be altered.
Of course, though understanding dental insurance is the responsibility of the patient, the reality is most dental offices offer services for verifying, estimating, and submitting your insurance. This is beneficial as not only is insurance complex and perplexing, but so is the dental terminology associated with the treatment. However, it is most important to understand that it is your dentist that makes recommendations toward your dental health and that your insurance coverage should never dictate your treatment and prevent you from receiving the care you need and deserve.
There is definitely more that can be said of dental insurance, and, as always, if you ever need help understanding your plan, call your dentist or feel to contact me for any questions at firstname.lastname@example.org. Happy smiling!
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