The insurance puzzle continues. The world of insurance changes frequently, partly because employers are looking for ways to cut costs so they can still offer benefits to their employees and partly because the insurance companies are offering suggestions of cost cutting measures.
Why are some services not covered by my insurance? Your employer determines what services will be covered and the percentage of coverage for each procedure. The insurance company is just administering the plan. Many times procedures that are considered cosmetic, or an upgrade from what would be considered the minimum treatment to restore a tooth’s function are not covered. A good example would be a back tooth that needs a filling. Dr.Shlafer would recommend a white tooth colored filling, and many insurance plans still cover for a silver mercury filling. In this case, you would be responsible for the difference. This is an example of a cosmetic upgrade. Most patients want non metallic restorations in their mouths and love having a tooth that appears to have no dental work on it.
Another popular question involves frequency limitations. Once again, the employer determines how frequently services can be done. A common example would be for a periodontal patient, this patient comes every 3-4 months for hygiene visits and wonders about coverage for their extra visits to care for their periodontal condition. Many plans only allow coverage once every 6 months, or 2 times within the contract year. This is why the patient becomes responsible for the 1-2 necessary additional visits.
Checking insurance benefits does require personal information. It is understandable that patient’s want to protect their personal information, and many insurance companies are using random ID numbers to locate your benefits. Unfortunately many still require the subscriber’s social security number, employer’s name, subscriber’s date of birth and the patients date of birth. We take every precaution to protect your personal information. It’s always a good idea to become familiar with your dental plan, so you are aware of your coverage details.
Insurance enrollment is just around the corner. Take a moment to read over your benefit choices. We are always available to answer questions. More on insurance–stay tuned.
