"My Insurance Will Take Care of It..." -think so?

Posted by Dr. Edward Magida | Filed under , , ,

Many people have dental insurance through their employer. Many people do not take the time to read their benefits book to see just what their insurance will pay for. I can't tell you how many times a person has broken a tooth and needed a crown to restore it, only to find out that their dental insurance offered to them by their employer is the "bare bones" type that pays for cleanings and not much else. Don't get me wrong, I'll take something over nothing, but insurance is not insurance is not insurance. There are many differences amongst all the plans out there. Even if one employer uses this same dental insurance company as a different employer, the plans, and the benefits they have, are many times different. How is a person to know what insurance he or she has, and just what it will pay for?

Trojan. I'm not talking about the horse. I'm certainly not talking about, well, you know. I'm talking about the name of a computer program certain dental practices have installed that will tell you exactly just what a specific persons' insurance will cover. It will list exclusions to coverage. It will tell how often a tooth can get a new crown. Is orthodontics in your family's future? It will tell the maximum it will pay per person. Knowing a patients yearly maximum for insurance, which it tells us, is helpful in planning treatment to maximize coverage. It is a really great tool we use in my office to be able to tell patients exactly how much they will owe for every procedure done.

Every month the database gets updated with either new employers and/or new plans. If an employer is not listed, all we do is make a phone call and very quickly we are faxed the information. That information is then placed in next months computer update so it is in our system.

Since we have installed the program, we have been much more accurate in telling people what they will owe at the end of treatment.

One thing I like about the capabilities we know have with this program. People who are not patients of our practice, have heard that we have the program and have called to ask us if we would find out and explain to them the type of coverage they have. In the interest of promoting better dental healthcare for everyone, we have gladly helped out all those folks that called, and will continue to do so.

If you recently got new dental insurance or you just never really looked into just what your plan pays for, ask your dental office staff if they can "trojanize" you and find out all you need (or wanted) to know about your insurance.

Dental Insurance: It's only part of the answer

Posted by Dr. Edward Magida | Filed under , , ,

Congratulations! You just landed that dream job you've been after for the past year. You get a car allowance, secretary, fancy office, cell phone and corporate credit card. Of course you'll also get medical and dental insurance. Medical insurance you've always had, but dental coverage is something new to you.
Let me give you a short course in dental insurance.

First of all, dental insurance started in the late 1950's. Back then the average maximum benefit was $1,000. Of course, the premium wasn't very high. And, a person could get a lot of dental treatment done for $1,000, 40 years ago.

The problem is that now, in the year 2000, most benefit maximums on average are still $1,000. If you need a couple of fillings and maybe a crown, your total fee could easily surpass that.

And, while this dinosaur of a figure, $1,000, has not changed, insurance premiums and dental fees are much higher than years before.

What's this all mean? It means that dental insurance should be looked at as a supplement. It is not all encompassing, but can be used to help pay for regular dental exams and hygiene visits. It's there to help pay for part of dental treatment fees.

I can't tell you how many people say they are not going to have a necessary procedure done because they are out of benefits. Or worse, a person finds out that crowns or bridges are not covered, and since they've been told their dental insurance is "the best" available, decide that because the procedure in not covered by their insurance company, it is not needed. (Ironically what the insurance company will pay for is the extraction of that tooth when it rots away.)

Do not let your insurance dictate what treatment you get. If something is not covered, that does not mean it is not needed. It just means that the policy you have does not have that kind of coverage. Look for better insurance and/or accept the fact that you are responsible for the most part, for the condition of your mouth.

Ask questions about the coverage available. If there is only one plan available at your place of employment ask why.

Dental insurance is not like medical insurance. Medical procedures can become very complex and extremely costly and potentially run into six figures for long standing illnesses or accidents. There is nothing in dentistry that even comes close to that potential. That's the reason for a lower benefit limit, and anyone with the need for any treatment that's more than just the basic, is going to incur out of pocket expenses.

With all the latest advances in cosmetic dental procedures, many people are upset to learn that insurance policies pay for very few of them. Insurance companies could care less that the poor appearance of a person's teeth keeps them from smiling.

Fortunately, many dental offices have established payment plans for people who need or want major dental work done. Many people are investing in their smiles because they know the payback will be phenomenal. To see the look on someone's face once they feel comfortable smiling again is priceless. It makes going to work a lot of fun.

Dental Insurance 101 ---A patient primer

Posted by Dr. Edward Magida | Filed under , ,

I am writing this article as a last ditched effort for people to try and understand just what it means to have and use dental insurance benefits. Please be aware that dental benefits have not changed much for decades, meaning that the amount an insurance company will pay is still the same it was 25 years ago, even though the cost of dental treatment has gone up like everything else.

I am going to list a bunch of things people have done or tried to do with their insurance as told to me by people in the dental profession. Sometimes things were done out of being ignorant of things. Other times things were done out of frustration. Hopefully, by reading about this topic you can get a handle on just what dental benefits you do have….or don’t have!

Here are things patients have done, or tried to do

  1. Not paid their co-pay for a procedure.- Very few procedures are paid in full by the insurance company.
  2. Not paid their deductible.- This is a once a year payment that is due to the dental office.
  3. Not paid because their insurance “maxed out”.- If you need a lot of treatment, and you use up your benefits, you still are obligated to pay your balance for the treatment you needed and authorized your dentist to do.
  4. Not pay for a procedure if the insurance company “downcodes” a procedure, and therefore pays at a lesser amount.-Insurance companies are not known for always paying for better quality materials used in many dental offices today. They will pay for what they consider “adequate materials”. Do you want your mouth to be “just adequate”?
  5. Play ignorant about their policy benefits.- If you do not understand just what is covered, call the company and ask them. It’s your plan.
  6. Play ignorant about their yearly maximum benefits.-At some point, if you have much treatment, your policy will max out and you will owe the entire treatment bill yourself.
  7. Get upset because “their dental office doesn’t keep track of all aspects of their policy”.- There are hundreds of policies out there. It is not possible to expect your dental office to know everything about all the policies.
  8. Get upset with their dental office because insurance is messed up, when in reality, the patient gave the wrong policy information to the office.-Make sure we have your correct birthday, social security number, insurance company address.
  9. As the office to falsify dates of service in order to collect benefits.-I’m not losing my license for anybody!
  10. Get upset when their dental office doesn’t keep absolute track of a person’s remaining benefits.-It’s much easier for you to keep track of your remaining benefits, than for your dental office to keep track of the benefits for several thousand patients.
  11. Get upset when their dental office does not know to the absolute penny, how much of a benefit is to be expected.-Many times we do not know exactly how much will be paid until the check arrives.

C’mon folks. Get real. Whose benefits are these anyway? They are not the dentist’s. The dentist is just trying to do what’s best for the patient. You the patient absolutely need to understand your own benefits. You need to know what procedures get reimbursed at what percentages. You need to know that certain procedures, although deemed necessary by your dentist, might not be covered. It is not the dental office’s fault if your coverage is lacking!

Dental insurance should be looked at as a possible bonus towards treatment you need. It should not be looked at as the reason to get or not get treatment.

If you have dental benefits, that’s great. It will definitely help with paying for your dental treatment. All I’m asking is for you to be part of the picture. It’s your plan and you should know what it does or does not do for you.