Dental insurance is a helpful bonus but it can be confusing and can appear misleading. Dental insurance is an agreement between the employer and the insurance company to partially pay for certain services. Dental Insurance helps in covering costs but does not intend to cover all costs. Every insurance plan, even within the same insurance company handles things differently. This extensive variety in plans keeps dental office staff and patients asking questions. Here are the TOP THREE!
Your fee is more than what my dental insurance company calls “usual, customary and reasonable or UCR” are you overcharging me?
When asked by state dental associations how insurance companies determine UCR fees, the companies consistently reply, it is privileged company information that will not be divulged.
If UCR were based on dental procedures for a specific geographic area it would be “reasonable” but unfortunately it is not unusual for the same insurance company to pay different UCR fees to the same dental office depending on which of the plans the patient is enrolled in. If data was complied accurately all plans, in all insurance companies should have the same usual and customary fees but they do not.
It appears the insurance companies set artificially low fees in an effort to enhance their profit margins. The result can challenge the trust of a patient toward his dentist. Insurance companies collect as much in premiums as possible, pay out as little as possible and delay payment as long as possible.
What is “in network” mean?
Some dental plans only pay for treatment if the dentist is contracted as a provider. Often “in network” plans are so severely discounted dentists are forced to lower the standard of treatment to participate. Dr. Frankel chooses not be participate in these plans.
Certain network plans allow a patient to be treated by an “out of network” dentist at an additional expense to the patient. Many patients opt for quality care “out of pocket”.
The staff at Dr. Frankel’s office with do a complimentary benefits check. You will be informed of your responsibility before treatment.
What is a dental coverage maximum?
The total annual amount your dental insurance will pay toward treatment is called your maximum. Dental coverage maximums are purported to increase with inflation and the cost of living. In the 1960’s maximums were around $1,000 and many still are. The general range of dental insurance maximum is our area is 1,000 – 3,000 dollars. The average dental crown in the United States was in 1960 was $60.00 and now it is $1,400.00
