A dental plan is nothing more than a contract between your employer and the insurance company to partially pay for certain services. No insurance plan is intended to cover all of your costs. There are deductibles – money you must pay first before insurance begins to pay anything. There are annual maximums – the maximum amount of money insurance will contribute towards dental work per year. Some services are paid on a percentage, and some services aren’t covered at all. All of this depends on the specific type of policy that you have.
Your employer buys a contract at a specified premium and includes as many or as few benefits as they are willing to pay for. Your employer is given a menu of dental policies from which to choose, and these packages vary in both the types of treatment covered as well as the percentage of the fee paid. It is a fact that the higher the premium paid by the employer, the higher the usual and customary fee schedule will be. This is why different insurance companies have different reasonable and customary fees for the same area. Ultimately then, it is your employer who determines how well your insurance covers your dental expenses. A usual, customary and reasonable (UCR) fee for a particular dental procedure for one insurance policy may be different than a UCR fee for the same procedure for a different insurance policy. The UCR fee for a particular dental procedure is different for each policy. So, there is no one UCR fee for a procedure. It’s all based on the insurance policy, and each policy is different.
Dental insurance companies do not know what is best for you regarding your dental care, nor do they intend for their plans to cover all expenses. Their plans serve only as an aid toward acquiring better care. Try to think of your dental insurance as a friend or relative who has decided to contribute some money for you to help you pay for the dental treatment that you have decided to have done. They have neither agreed to the treatment that you have decided to have done, nor have they agreed to pay for everything. They are just helping a little bit for certain procedures.
When you agree to be treated by your dentist, you accept direct responsibility for paying your dentist. Your dentist works for you, not your insurance company. If you are fortunate to have dental insurance that may assist you with the cost of treatment, the dental office can complete and submit all dental insurance forms to achieve the maximum reimbursement to which you are entitled; however, ultimately, you are responsible for the entire bill. So, if, for whatever reason, your insurance doesn’t pay what was estimated, you will need to satisfy the balance. While the dental office may assist you in filing insurance forms, they cannot guarantee any estimated coverage.
To have dental insurance is a good thing, because it can help pay for some of the necessary dentistry that you want and need, but be sure to keep it in perspective. Insurance companies exist only to make a profit. While insurance premiums have gone up over the past 30 years, the average annual insurance coverage is still the same as it was 30 years ago…..$1000. If you factor in inflation, your insurance benefits should be over $4500! The insurance company gives you less coverage and charges you more for it. Their main objective is not to provide you with the best oral health care that you deserve; that is the job of the dental office.