Over the years, I have heard the same statements from so many patients. Patients are shocked to hear that they may not get the benefits promised to them. So with that in mind, I would like to provide you some basic insurance information and terminology used by the insurance companies, in hopes that these ongoing articles will help you understand your insurance benefits. Here are a few examples of some of the questions I have been asked:
Question: Why didn’t my insurance pay for my cleaning, when I get 2 free a year?
Answer: Most patients are under the impression that the insurance company will pay for two of their hygiene visits. Generally they will, as long as you have not used all of your annual maximum.
For example: You have a $1000 maximum, treatment has been completed in either our office or with a specialist, If the cost of these combined visits have met or exceeded your annual maximum, you will not have any remaining benefits to be paid out for additional treatment or cleanings; your hygiene visits are included in the annual maximum. Therefore, your hygiene visits will only be covered providing you have the benefits to cover them.
Question: My friend and I have the same insurance, why does her insurance pay more than mine?
Answer: Did you know that Dental plans are typically business arrangements between an insurance company and the employer. It is your employer who decides what type, and the amount of coverage you will receive.
For example: 2 patients work for different employers but have the same insurance carrier. One employee may have a $1000 per year maximum, the other a $3000 per year maximum. One may have a traditional plan that covers anywhere between 50 to 80% on procedures and the other plan covers 100% of procedures. Why you ask? Well, that is what the employer has decided to offer its employees.