The complexities of dental insurances have faced many of us. The most important thing to remember about dental insurance plans is that it is not a “ Pay all “ situation. In British Columbia alone there are at the minimum of 25 different insurance companies and that is not including private plans.
Each one is a little different in what they will and will not pay and added to that is the patients maximum benefits allowed on an annual basis. All of this is determined by employers and the contracts they have with their members. By that we mean that, the employer enters into a dental plan contract with a third party that will act as the plan administrator. Dental Plan contracts are lengthy, complex documents that define what service are covered and under what circumstances necessary treatment may not be covered. Then there is the frequency that procedures may or may not be covered. In essence………………a mire!
When entering into a dental insurance benefit plan here are the items that you should be clear on;
- Annual Maximum allowed for both individual and family. If there is no maximum, well BRAVO YOU! But for most it can be as little as 1000.00/ per family member and if you have two hygiene appointments and a few fillings, well, it can add up.
- -Frequency of treatment. In this instance that can be everything from scaling, polishing and fluoride, all the way to fillings and crowns
- What is your percentage for Basic ( cleanings ,filling, extractions and root canals) Major ( crowns, Bridges etc) and Ortho .Now here it can get tricky as the fees are based on what the College of B.C. Dental Surgeons have put forth in a yearly fee guide. Many dentists charge higher than fee guide and that is based on their level of expertise. Fillings on molars may only allow for a amalgam fee which is paid at a lower rate than say a white, composite filling .
We have merely brushed the surface of the topic and already many of you probably need an aspirin by now. The most important thing to remember is that there are only two institutions that are making huge profits……………..Banks and Insurance Companies. With that in mind always be aware of what your insurance will do for you. If at the end of the year your monthly premiums are more than what your maximums are, well perhaps you need to do a bit more research.
Remember this is your plan so be informed about what you are getting for your hard earned dollar! If you have questions, call them and get the facts before you get the surprise.
As always we are happy to send off preauthorizations to see what your plan will cover but in the end it makes good sense to know your plan! In this case knowledge is NOT a dangerous thing.