Dental coverage is funny. You don’t really buy it-someone else decides what you want. Your employer purchases a plan for you or gives you an option to buy one of a few plans. The insurance person sells a plan to the HR person at your company. It is never about your needs or dental health. They come in and want your HR person to buy their plan for the employees. The insist that it is really a great plan and covers so much for their faithful employees. They offer a cheaper price to the company than what they had last year. To get the discounted price they include some limitations to coverage that were never in previous plans. They sell a small amount of coverage for a price that the company can afford. The company feels good about offering some dental coverage as many companies no longer do so. The employee is happy to have dental. They are usually happy until they go to use it. Then they don’t understand why they have to pay. Some people think dental insurance covers everything. It never does. Some think it covers 100% it rarely does. The handbook that you get goes over some guidelines but can be very confusing. It is even confusing to us sometimes. Changes with insurance are coming very quickly as a way to save companies money. The changes are usually ways to limit care or get you to pay out of pocket for your needed services. Dental insurance uses language on their EOB that makes it look like the charges were excessive or unnecessary. Most dental offices have fees that are very similar. One office does not charge considerable more or less for a service-fees are pretty set by what insurance companies will reimburse. The fees for our office fall into the acceptable range but insurance companies have been reimbursing less and less each year. Dentists all across the country are seeing reduced payments from all insurance companies.
Most dental insurances limit the number of exams you can have each year to 2. That means if you get more than 2 toothaches a year those emergency exams are not covered. It also means if you have your teeth cleaned regularly and get just one toothache that emergency visit is not covered by your plan. X-rays that were generally covered as recently as last year are sometime only being covered at 50 or 80% and they have now been subject to a deductible. To the patient who has had their teeth cleaned twice this year and they now have a toothache-that exam will not be covered-they will need to pay out of pocket to be seen. The services may be covered if the patient has not reached their yearly maximum yet though. Patients also need to be aware of their maximum benefit for the year as anything over that amount would be out of pocket. Some people do not know that their “2 cleanings a year” go toward their annual maximum. If you have a maximum of $1000 any insurance payment made for you will go toward that allotment. Any dental services received at a specialists office will go toward that maximum as well.
Recent graduates and new hires are hoping to get some dental insurance since they have neglected their teeth. They get excited to be “covered” or have dental insurance. They do not understand that they are usually getting minimal yearly maximum of $1000. They have had issues over the last few years but no dental coverage. They let these small problems grow while waiting to get a better job or a job with dental insurance. They do not look into the plan they just get “covered”. When they finally arrive in the office they are surprised that the plan will only cover taking care of 1 tooth. They waited and now their small fillings need costlier care. I wish I could get to them earlier when they had small issues so that we could take care of them when they were small, less painful and cheaper. Tooth problems do not care if you are covered by dental insurance. The problems grow over time getting bigger and less manageable. Do not hesitate to see the dentist if you are having a problem. Find a dentist you can work with to achieve your goal of a healthy mouth.
If you are looking for a new dentist we are located in Gilbert, AZ. Feel free to call us to set up a tour of the office or a new patient visit. Katie and Mindy are also available to answer your dental insurance questions at 480-507-1807.