Having dental insurance does not guarantee that you will be allowed to have the procedures you want and need done. Many dental patients have found some insurance carriers to be difficult to work with, denying claims and causing stress for both the patient and dentist. Here are a few facts about dental insurance everyone needs to be aware of:
FACT # 1:
Your dentist can not make them pay. Your dental insurance (and the procedures it covers) is determined by a contract made between your employer and your insurance company. When questions arise, your best course of action is to call your human resources department or insurance carrier yourself.
FACT # 2:
Dental insurance is not a pay-all, but rather an aid. With most policies now capping at $ 1,000 a year per patient, dental insurance is not meant to cover all of your costs like health insurance, but to ease the burden of dental care a bit.
FACT # 3:
Even if you have 100% coverage, your dentist may not get 100% of his fee, leaving you in some cases, to pay the difference. Most insurance companies survey the area in which your dentist is in practice, calculates an average fee for all service providers in that area including discount dental clinics, take 80% of that fee and consider that the appropriate fee, paying only that amount.
FACT # 4:
If you and your spouse have policies through your own employer (but with the same carrier), the insurance company is not required to use the second policy to pay for uncovered costs, as is the case if you have coverage from two different carriers. Sad but true, insurance companies can accept payment from two different employers for coverage, but still only give the employee and his / her family members the $ 1,000 spending limit according to many state's laws. I, however, you and your spouse have different carriers; you can use both insurances to cover most, if not all, of your dental fees.
FACT # 5:
Many routine dental services are NOT covered by insurance companies.
FACT # 6:
Your insurance carrier is not responsible for paying for dental work that has not been preauthorized – even if it's an emergency! Be sure that your dentist's office files for any preauthorization are necessary before agreeing to any procedure.
With so much misunderstanding regarding dental insurance coverage out there, it is very important for every patient to carefully discuss their policy and its requirements with their dentist's business manager before agreeing to any expensive procedures to insure that they will not be left paying for the entire bill.