All dental insurances and their coverages used for the discussion in this blog is based on PPO insurances only. PPOs is the only type of insurance Georgia Prosthodontics Smile Specialists are accepting.
Dental insurances first and forth most is a business. As a hard working americans we have set certain standards and expectations for the services we are pre-paying for. As the law has changed requesting a mandatory medical insurance to avoid penalty, many have taken a step further and jumped into the purchase of dental insurance as well, though not mandatory but not known by many.
There is a huge difference between a self-purchased dental insurance vs the one provided by your employer.
What Sets the difference?
Self-purchased: Think about this, if you are looking to purchase a dental coverage it is probably because you need it. Insurances know that and you end up paying for an superficial dental insurance that sounds good on paper but covers nothing and I do mean nothing. Our office has come in contact with a few companies, so if you hold mentioned plans, I can almost guarantee you fell victim to an overpriced dental coverage with no benefits. Here are the top three: Blue Cross and Blue Shield, Humana and Obama Care Dental Plan (may go under another name) These plans on average have $150 annual deductible before benefits kick in, however, when you have satisfied the deductible there still no coverage because there is 12 months waiting period and if that was not enough, there is also an age limit of 18 years of age. Forget about crowns, implants and even fillings, these services are not covered! Yes, my friends as sad as it sounds it happens, unfortunately to all over them. When you call our office and you happened to hold one of the above mentioned plans you will be paying out of pocket for the first visit. So, we are educating our patients and most of them end up canceling premiums for obvious reasons. Here is a true example that happened in our office. Our patient X was paying $34 a month for a dental coverage, equals to $408 per year however her annual services do not exceed $353!
Employer sponsored insurance: Most of them have an average annual coverage of $1500 and a deductible of $50. Each plan will have it is own specific coverage and limitations. Biggest mistake that patients make is to believe that insurance will cover all of their services and it is not true. There is a percentage that insurances allocate per certain procedure, and do not be surprised if they choose not pay remember what I said in the very beginning, it is a business. Think about your dental insurance as a form of payment and not a guarantee of payment. Dental insurances are not obligated to pay and you should be prepared to cover the costs not covered by the plan. Many people are not aware but claim submission is a luxury denied by many offices. It is an expense that we choose to undertake for our patients and even go a step further, behind the scenes if you will, submit up to three appeals should your claim gets denied. Likely our team is self sufficient and well trained in understanding your coverage and maximizing your insurance towards your treatment. For patients undergoing complex treatments we suggest a simple math approach, from your total cost of treatment subtract annual coverage, the rest is your out of pocket expense.
No matter how and where you get you dental coverage it is important to know that no dental coverages are alike, the payout may differ from patient to patient even among your co-workers.