Confused about dental insurance?
Dental insurance was introduced in the 1960’s and was originally designed to help with the cost of dental expenses, not pay for the entire treatment. This benefit was exciting for those who were beneficiaries from the generosity of the automotive companies. These benefits gave the opportunity for many to have needed dental care done. The dental benefits haven’t changed much in the last 40 years in the Detroit Michigan area. In fact they originally had a $1000 maximum per year which is now $1,200 per year: only 20% of inflation rate. Today in this economy having insurance is a blessing and at the same time it is confusing. This month’s article is designed to help you understand your dental insurance better. Here are some facts:
1. Dental insurance is a contract between the insurance company and the patient.
Each year whether it is a calendar year running from January –December or a contact year running from July-June, the insurance company allows a maximum amount that they will pay the dental provider on your behalf. The maximum is usually $1000.00. Some plans also have a deductible, which is to be paid each year, generally $25.00-$50.00.
2. Insurance companies pay a percentage of each procedure.
Here is a breakdown:
100% -Diagnostic and Preventative services, which includes exams, cleaning and x-rays
80%-Basic/Restorative services, which includes fillings
50%-Major/Restorative services, which includes, root canals, crowns and prosthodontics (dentures, partials and implants)
3. Due to insurance companies paying by a percentage, your out of pocket expenses can vary. If you decide to see a dentist that is not in-network you may have to pay more since the insurance company pays a limited amount for each procedure. To make this profitable, dentists who agree to participate with these plans may need to see more patients at one time or reduce their expenses by using less quality materials or labs.
With the collapse of the auto companies it became necessary to reduce or eliminate benefits. There are many decisions now that have to be made which in the past were made for the employee. At the same time these benefits are becoming evident which in the past were assumed.
If you have a PPO (Preferred provider organization) plan:
-You may need to pay slightly more money but still have choices in the dental office who provides care for you and your family. If you have no choice but to find a dentist in your network it can be difficult.
-You may need to check with your insurance provider for a list of dentists that participate with them. To make sure these dental providers meet your standards it may be necessary to evaluate their office by checking over the internet or by asking friends.
If you are in need for insurance:
Selecting a dental insurance company can be difficult and confusing as well. Delta Dental has a contract with AARP that may work for you. You can visit www.deltadentalins.com or call 1-866-583-2085 for more information.
Please feel free to call our office with any questions you may have. You do not have to be a patient of ours for us to help you out. You can also visit our website at www.TheGentleDentist.com or call us at 586-247-3500.