Understanding Your Dental Insurance

Understanding Your Dental Insurance

We believe in putting our patients first.

If Dr. Homonnay is “out of network” in your current plan, please contact our office at (615) 221-8837 or [email protected] to see how we can make treatment comparable to an in network practice.

Our team is trained to quickly help you evaluate your insurance, your current dental health needs, and a course of action that works best for you and your finances.

Explore the tabs below to learn more about how dental insurance works.

Traditional Insurance vs. Dental “Insurance”

When selecting and signing up for the dental portion of your health insurance, the term “Dental Benefit Plan” would be a more accurate description.  This is because dental insurance plans offered to you are structured very differently from traditional insurance.

Difference #1: Traditional insurance (fire or flood insurance, car insurance, etc.) is purchased for the rare and unexpected disaster or tragedy; you are hoping that you might never in your life have to use it. Damage to your teeth, however, is neither rare nor unexpected; it is part of the natural aging process. Dental insurance is purchased knowing that you will certainly be using it in your lifetime.

Difference #2: Traditional insurance does not cover preventative care; for example, fire insurance does not pay for chimney cleanings, nor car insurance for oil changes. (Health insurance used to be designed this way, but has evolved to expand coverage – and the high premiums reflect this.) The primary benefit of dental insurance is that it does cover preventive care: exams, cleanings, fluoride, etc.

Difference #3: (Here lies the primary misconception.) Traditional insurance covers most or all of the costs incurred when the disaster you’ve been insuring yourself against strikes. Fire insurance covers the cost of your house that burns down, car insurance covers the worth of your car, and health insurance covers much of the hospital bill. Dental insurance normally helps cover just part of the cost of treatment, like a sliding scale discount – the higher the cost of treatment, the less the insurance covers.

So why is so little covered in dental insurance plans?

The first distinction of dental insurance plans are the difference in premiums rates. Dental insurance premiums are usually quite low, averaging around $30 a month or $360 per year. Here, the phrase “you get what you pay for” applies. Traditional insurance is a pooling of funds from many people who want to protect themselves, but funds are only paid out to the few that actually experience the disaster. Not so with dental care – everyone needs it, and as patients grow older they generally need more care for their teeth. Insurance companies know this, and so they offer more of a benefit towards treatment, not full coverage.

With dental insurance, the insurance company has a “maximum out of pocket” – not you! They have set the amount (usually no more than $1500 a year, if that) that they will contribute towards the patient’s care, and then the patient pays the remaining balance.  The most odd thing about this is since the 1970’s when dental insurance was implemented, the yearly maximums the insurance provides have not changed. (Even though cost of living and inflation have increased)

Is the benefit helpful? Yes. Does it work like traditional insurance? No.

The article “Dental Insurance That Covers Everything?” from DentalPlans.com assists further with illustrating how dental insurance works. “Indemnity dental insurance” is described as “traditional dental insurance” – meaning this is the way most original dental plans were formulated. As you read on, you will see that these still likely include many of the limitations in the following tab.

There are often many limitations in dental insurance plans that are important to understand when selecting your plan.

1. “In Network” vs “Out of Network”

Like health insurance, some plans only offer full benefits when you visit a provider who has contracted with that insurance plan.

2. Fee Schedules

Usually, even with “in network” dentists, the insurance plan has only agreed to cover procedures at the MAC (Maximum Allowable Charge). If there is a balance, the remainder is billed to the patient.

3. “LEAT” – “Least Expensive Alternate Treatment” Clause

Some dental insurance plans have a LEAT clause, which means the plan will only cover the least expensive option for treatment (if there is one). For example – they might cover amalgam (silver) fillings, but not composite tooth-colored fillings. As is the case in many situations, the patient may decide that the least expensive option is not the best option for their health or lifestyle.

4. Annual Maximums

Another important stipulation of many plans is the annual maximum – the “out of pocket maximum” for the insurance company towards your care. These are especially important to take note of if a plan indicates it covers a high percentage of treatment (e.g. 80% of basic restorative services and 50% of major restorative services).

5. Other Common Limitations

Waiting Periods – a period of time after the effective date of your insurance you have to wait to be covered for certain services.

Missing Tooth Clause – the exception that excludes treatment for spaces where teeth were missing before the effective date of your insurance (commonly bridges and implants).

Frequency – a plan that only allows certain services after certain intervals (e.g. only covering x-rays every 3-5 years).

Is dental insurance or a dental benefit plan useless? No!

In most cases you will certainly save money above and beyond what your premiums cost you, however we encourage you to discuss all dental plans available to you with your employer or insurance agency and thoroughly understand their benefits before selecting one. Simply the benefit of having routine preventative visits (exams and cleanings) covered for you is the ideal incentive to make sure you are doing everything you can to keep your mouth healthy and catch problems like decay as soon as possible before they turn into costlier treatment.

Because we are unable to accept all dental insurance plans our team at Hallmark Dental has carefully constructed a Practice Membership Plan designed to provide the best benefits to you and your family.  It is an excellent alternative that most of our patients prefer over their employers dental insurance. Click here to learn more.

If you’re ready to explore another option that provides better or at least comparable benefits for you and your family, click here to learn about our Practice Membership Plan or contact us at (615) 337-6306 or [email protected]

Find out why so many of our patients love this simple yet very affordable plan that fits your needs and saves you more money than most contracted dental insurance plans.

For more information or to schedule an appointment, please contact Dr. Tomi and our team using the communication below that is easiest for you; we look forward to meeting and caring for you and your family!

Call (615) 221-8837

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