April 28, 2010
I would like to offer a big thank you to all who made our first dental information session a success. We discussed many of the misconceptions of dental insurance and gave some insights into how to avoid problems. If you were unable to make this meeting, I will cover a few of the major points discussed.
First, if your HR office informs you that your plan has 100% coverage, this is most likely not correct. Most plans pay preventive care at 100%, basic at 60 to 80%, and major at 40 to 50%. If you notice, my wording was “pay”, not cover. Your plan may cover 100% of the procedures in our code book, but will pay at the above rates. Watch the wording in your plan.
Second, most plans have limitations and exclusions. We do not know what these are since every plan is different and there can be hundreds of plans available in the marketplace. Please read your benefits booklet or bring it along to the office so we can see what limitations there are.
The other wording that is written into plans that is confusing is “alternate benefits”. This means that if there is more than one method to perform a procedure, your plan will only pay for the cheapest one. This plan is a less expensive one to purchase for the buyer.
UCR is another confusing term. It stands for Usual, Customary, and Reasonable. This UCR fee which is applied to a service is considered a made up number by the insurance companies. They will not make public their criteria for arriving at this number, so no one can challenge or dispute their findings. Until insurance companies allow independent confirmation of their data, consider this number to be “made up”.
For everyone that was at our meeting, I hope you learned more about how dental plans work. Our office plans on having more informative meetings on a wide range of topics. If you have a topic of interest, please contact us and we will attempt to cover your topic.