Dental insurance and understanding the benefits that are available can be a very frustrating experience. What is covered and what is not covered is often dictated by how contracts are written. Understanding these agreements can be confusing. What is an annual maximum and how is it calculated? What are “usual, customary and reasonable” (UCR) fees and why doesn’t it relate to current costs? How can I make sure that I get the benefits that I deserve? We deal with insurance claims daily for many of our patients to help them maximize the resources that they are entitled to, as a service to help them afford the dentistry that they need and want. Although we cannot possibly be an expert on every dental plan, you be can be assured that we are your best advocate in helping you get the best coverage possible within the limits of your plan.
Insurance companies work with the employer and structure the coverage. Dental insurance for traditional indemnity plans, are agreements between the employer and the insurance company and have nothing to do with the actual dental providers: your dental practice. Obviously, benefits provided by insurance companies are related to the costs of the plan to the employer. Many companies may have more than one plan within the organization and your coverage may fall under different guidelines depending on seniority or even the position you hold. It is always best to discuss your particular coverage with your insurance carrier or your benefits administrator. In a response to control costs, we are seeing that many companies have increased deductibles, reduced allowable fees and extended waiting periods for replacement and major services (crowns etc.), which unfortunately means more out of pocket expense.
The key is to get the correct insurance information to us in a timely fashion to help you prepare for your investment in your dental health. We can facilitate your understanding of your estimated out of pocket costs by pre-authorizing any non-emergency type procedures. In this way you have a good idea of the costs before treatment is rendered. We are happy to assist you in the submission and reimbursement process. There are also payment plans available to allow you to spread your out of pocket costs over a longer period of time. This allows many patients to get the dentistry they need in a more affordable fashion, without allowing the deterrent of fees to compound your dental problems. It is important to remember however that benefits can change and anniversary dates can affect the available resources. Although we make every effort to help you understand and maximize the specifics of your plan, in the end, it is the your responsibility to meet the financial obligations of dental treatment. Remember that if you have questions, call us. We are here to help.
Cindy Filanowski is the office coordinator for Scott Finlay DDS & Associates, in Annapolis, Maryland. The dental office is a comprehensive restorative practice and a recognized leader in dental esthetics. The mission of the practice is to provide dental solutions to patients to enhance and maintain their best possible smiles. More information can be found at www.AnnapolisSmiles.com or by dialing 410.757.6681.