DENTAL INSURANCE – PART II of II
“BUT…MY PLAN SAID I HAD COVERAGE FOR THAT TREATMENT”
Ever get a great coupon in the mail for your favorite department store, only to get to the register and find out you can’t use it for the item you are trying to purchase because you didn’t see the long list of exclusions on the back? At that moment, you then need to decide if you are going to purchase the item or put it back.
Dental insurance policies are just like department store coupons – there are a lot of treatments that are covered, but there are also a lot of exclusions listed in the fine print. All too often the patient finds this out when the insurance company rejects a claim for treatment. That being said, the difference between the person at the department store and the person who just had their dental treatment rejected is – the person at the register can put the item back and not be held financially responsible for that item. The patient who signed an annual contract with their insurance company, however, cannot terminate their policy until the next annual open enrollment period comes up. They are now not only responsible for the dental treatment they just had, but they are also legally obligated to pay monthly premiums for dental coverage that does not necessarily cover everything that was originally thought.
As mentioned in part I of this series (see Dental Insurance Part I), a common misconception about having dental benefits is that it will cover all treatment, however, this is not the case.
COPAYMENTS, DEDUCTIBLES AND MAXIMUMS…OH MY!
Dental insurance companies typically have coverage tiers, which include coverage for preventative (such as routine cleanings), restorative (such as fillings) and major restorative (such as crowns). Each tier is paid at a certain percentage after a deductible is met, up to whatever annual maximum dollar amount the insurance plan agreed to pay out.
WHAT IF I USE UP MY MAXIMUM BEFORE THE YEAR IS UP?
If your dental insurance policy allows $1,000 per calendar year for your dental treatment and you surpass that dollar amount, you are still obligated to pay your monthly premiums for dental coverage. For example, if you are paying $75 per month for your dental coverage and you have treatment that uses up your maximum in March, you still have to pay your $75 per month premium, as well as pay out-of-pocket for your remaining dental treatment for the remainder of the calendar year.
When shopping for dental insurance, remember to closely evaluate the fine print so you understand the benefits and limitations of the plan.
Questions about insurance? Reach out to us at (781) 942-2020 or by e-mail at info@drkhull.com. We also have in-house membership plans for patients with no insurance – visit the Kleer Membership tab of our website to find out more.