Dental Insurance has been around for over 30 years. The typical maximum benefit then was about $1000 for a calender year. Some 30 years later, the maximum yearly limit is still $1000, yet premiums have risen over 400%! If dental insurance companies kept up with the value of the dollar and inflation, they would be covering approximately $8,000 per year in treatment not just $1000! You read that correctly. As a result, insurance companies place limits on what they cover, and prolong the reimbursement process with unnecessary, and repetitive paperwork. Ultimately, it is the patient (the insurance company’s policy holder) that suffers from this. Remember, the insurance companies are a business, and are hoping that their clients never even use their benefits. Can you imagine being in a car accident, totaling your car, and the insurance company says “we’ll give you $1000 on that claim for the year”. That would be fraudulant, and unacceptable, yet the public has accepted that as standard practice from the insurance companies.
PPO’s-(Preferred Providers) does not mean you are required to go to a participating provider. They will lead you to believe this, but this is just not true. It allows you some power in deciding who in fact you would like to be YOUR doctor, not just a name from a list. If you go out of ‘network” you will still maintain ALL of your benefits. Their coverage is slightly less, but you make up for it in reduced premiums. It is a wash. So stop letting your employer decide which doctor you see with one of “their” contracted doctors. You can still come to me and maintain all of your due benefits. We file all of your claims on your behalf, so you do not have to do a thing.
Many insurance companies use the “LAB” principle. It is short for “Least Alternative Benefit”. It basically means they will pay for the cheapest material or treatment they feel is adequate for you. This is very broad power given to someone behind a desk that has never examined you.
Consider insurance as a “pre-paid’ gift certificate that is good for $1000 or so, and it expires December 31 if not used. Insurance companies know people do not go to a dentist regularly, and sometimes for just two cleanings per year…the cost of a good haircut! Yet, they received full fee for the premiums.
BUT WHAT IS THE GOOD NEWS?
The good news is that you have $1000 or so due to you for your treatment!!!! We gladly file for you, and as previously mentioned, you can still see me although I am not a “preferred provider”. We will do everything to maximize the benefits due to you. So don’t procrastinate any longer. Get your mouth back to the healthy, beautiful condition it was meant to be in.