It Pays to Know About Your Dental Insurance Benefits!, Part II
Welcome back for Part II of our discussion on dental insurance benefits. In Part I, we talked about the categories and types of dental benefit plans, some of the specifics on how plans work, and a little on what they commonly do and don’t cover. Today we will address some considerations on choosing a dental benefit plan, the communication between the plan and you after a visit to our office, and some frequently asked questions and myths.
In this blog we will also tell you a little about our in-house dental benefit plan. We call it the Concierge Plan. We developed this benefit plan for patients without insurance for any number of reasons: self-employment, retirement, insurance not offered, insurance offered but not a good plan, etc.
As always, if you are a patient of any type of practitioner, it is your duty to know and understand your benefits. To be as informed as possible, you need to research your dental plan benefits. We are always here to help you navigate these confusing waters. Don’t hesitate to talk with our dental team about your benefit plan.
What to Consider
If your employer offers dental coverage, that’s an easy choice. Sometimes it is less expensive than getting a policy on your own, but do your own calculations. It may be that using our Concierge Plan could save you lots of money and frustration. If you’re shopping for your own plan and you already have a dentist, your dentist may be able to help you estimate your needs based on your dental history.
As you compare plans, try to find out the following things:
- Total costs for the plan each year, including premiums, co-pays, and deductibles
- Annual maximum benefit
- Limitations on pre-existing conditions or missing teeth
- Coverage for braces, if needed or anticipated
- Whether you can choose your own dentist or they dictate your options?
- Who controls treatment decisions: you and your dentist, or the dental plan?
- Whether the plan covers diagnostic, preventive, and emergency services, such as sealants and adult fluoride treatments?
- What basic and major dental care is covered, such as metal-free restorations and implants?
- Ask about excluded procedures
If you are covered under two dental benefits plans, tell the plans about your dual coverage status. In some cases, you may not have full coverage from both plans where the plan benefits overlap. You may not receive a benefit from both plans when they both have coverage for the same procedure. This is known as coordination of benefits.
As your dentist, we can NOT answer specific questions about your dental insurance plan or predict what level of coverage for a particular procedure will be. Your benefit plan will only give us very limited basic information. Each plan and its coverage will vary based on the Usual, Customary and Reasonable (UCR) limit arbitrarily set by your individual benefit plan or a negotiated contract. If you have questions about coverage, contact your employer’s benefits department or your dental benefit plan directly.
What Is an Explanation of Benefits (EOB) Statement?
Your Explanation of Benefits (EOB) is a paper or electronic statement provided by your dental plan. It breaks down benefits for any dental treatments or services that you have received. It is sent to you after your dentist visit, and outlines your costs, the treatments that were covered under your dental plan, and treatments that may not have been covered and why.
Why Is Your EOB So Important?
An EOB provides information including treatments performed, our fees, insurance payments, amount you may owe for deductibles, co-pays, or procedures not covered by your policy, coordination of benefits information (if applicable), the portion of your annual maximum that has been used, and the amounts you have paid toward the deductible this year.
An EOB presents the opportunity to make sure your benefit plan is paying the amount they should for the service you received, and that the deductible and percentages are what your plan promised you. Therefore, understanding the different parts of an EOB is critical to finding and avoiding insurance underpayment.
Here Are Some FAQs About EOBs
As if there are not already enough acronyms on this topic!
Is my explanation of benefits a bill?
No, an EOB is not a bill. On the most basic level, your EOB will provide a breakdown of the dental services that you received, the amount your dental insurance will pay to Dr Van Huffel and can estimate any portion you may be expected to pay. A bill for any amounts you may owe will come separately from our office.
When will I receive my EOB?
We will bill your dental insurance company after you’ve received treatment, and then you will receive an EOB. You will usually receive an EOB before you receive a bill from our office for any amount you may owe.
Myths and The Truth
Myth #1: My dental plan should cover all the costs of my dental care.
Fact: Dental plans are designed to help pay for a portion of your dental costs. Some plans cover 100% of what the plan determines as their own UCR for preventive and diagnostic services and between 50% and 80% of the plan determines UCR for basic and major services. Your cost and coverage depend on the procedures that are a part of your personal dental benefit plan.
Myth #2: My dentist has recommended an appropriate dental procedure, but it is only partially covered or not covered by my dental plan. My insurance plan wants to down-grade the procedure. Does my benefit plan have the ability to force me to choose a lower quality treatment?
Fact: Absolutely not. While your plan may only cover certain treatments, you and your dentist should always decide what is best for you. Benefit plan employees are almost never dentists and therefore are not in a position to decide which treatments are right for you. Don’t let the plan administrators decide your treatment for you.
Myth #3: A note on my EOB indicates that my dentist’s fee is more than my dental insurance allows for a procedure. Is my dentist over charging me?
Fact: No, your dentist is not over-charging you. Dental plans set limits for the amount paid for any treatment based upon their individually determined fee schedule, not your dentist’s actual fees. The plan administrator will pay an amount based on a percentage of their own UCR, which depends on the benefit level of your specific plan.
Myth #4: My dental plan is better able to determine my dental care needs than my dentist.
Fact: Dental insurance companies are businesses with shareholders that demand the company is profitable. That profit comes from paying no more in benefits than they are absolutely required to per the contract they signed with an employer or individual. They do not have your best interests or health in mind.
Dr. Van Huffel is educated to diagnose and treat oral disease and promote oral health and disease prevention. This requires a pre-dental education from a college or university, followed by a minimum of four years of dental school. In addition, after graduating from The Ohio State University College of Dentistry DDS program, Dr. Van Huffel received an extra year of training at the Oral and Maxillofacial Surgery department at OSU for training in surgical and sedation procedures. She is a doctor of oral health who has taken the time to examine and study your personal oral condition and develop a treatment plan for your specific dental needs. The cost for your care is based on what treatments your dentist recommends and your personal needs.
Dental plans often limit your options through a contract with your employer and are not based on your individual needs. So, be sure to talk with us about your individual treatment plan and any questions you may have about your dental benefit.
The Concierge Plan to the Rescue!
The Concierge Dental plan is a monthly plan that allows patients to receive quality dental care at our office for reduced cost. Patients pay one low monthly fee and have access to preventive care every 6 months, including x-rays, exams and cleanings. If patient’s need dental treatment like fillings or crowns for example, they can receive 15% off that treatment. It’s similar to a cell phone plan- you pay monthly for service all year long.
Don’t Despair; We Will Help You Through It!
I hope these 2 blogs have answered a lot of your Dental Benefit questions. This certainly has not covered all points on the topic.
Please contact us today to set up an appointment to achieve the healthy, beautiful smile you have always wanted. We will help you get there!