Questions and Answers about Dental Coverage

START WITH THE BASICS

 

  What is Dental Coverage?

Dental coverage, or more correctly a dental benefits plan, reimburses you for certain dental expenses according to written agreement.

Dental benefits usually are provided under a contract between your employer or union (the plan's "sponsor") and an insurance company, sometimes referred to as a third-party carrier.

 

  Why Do Rates Increase?

In general, rates go up to reflect rising costs, increased use of benefits, or an increase in the fee charged by the insurance company. Sponsors sometimes reduce your benefits to postpone rate hikes.

 

  $$$ vs. Care

Some plans have not kept pace with advances in dentistry, so you may find certain common procedures excluded or severely limited. Also, a plan may allow the insurance company to substitute a cheaper service that, in the carrier's opinion, is professionally adequate.

Understandably, people make health care decisions based on how much their coverage pays, assuming insurance will always take care of basic needs. Since this is frequently not the case, preventive measures and needed work are postponed.

DON'T DO IT. Prevention is the most efficient and least costly way to protect your oral health. Once dental disease develops, it will not heal without treatment.

 

  General Health Insurance vs. Dental Coverage

Unlike diseases of the rest of your body, problems that affect your oral health usually are preventable, making catastrophic dental coverage generally unnecessary. It is not valid to justify increases in dental insurance premiums by comparing them to escalating health care costs. Be wary of this kind of explanation. It's like comparing apples and oranges.

 

SOME THINGS TO CONSIDER:

  A Prevention-Oriented Program

A good dental plan should include 100 percent coverage for all diagnostic and preventive procedures. Any dental plan should respect your right to choose your own dentist.

 

  The Doctor/Patient Relationship

People stay with a dentist whose skills they know and trust. The relationship between a dentist and a patient is threatened as new programs are designed to make group coverage less costly for sponsors. In some cases, the new policies don't cover treatment provided by your family dentist.

You are the best judge of dentists. Neither an insurance company nor your employer knows your individual preferences or needs. They should not choose your dentist for you.

 

  Your Individuality

Your individual needs may not have been taken into consideration in defining group coverage. To create a picture of an "average" patient, you and your co-workers are reduced to a series of numbers that reflect age, education, and marital status. You can average numbers. There is no such thing as an average person.

 

  Your Best Interests

Your coverage may be negotiated by administrators whose primary concern may not be your family's dental needs. Have you ever wondered how your reimbursements are determined? Who judges the appropriateness of treatment agreed to by you and your dentist? Where is that person located? Does that person have the dental training and education to make such decisions?

 

  Your Influence As A Consumer

No matter who pays for your dental benefits, you have a right to be heard. Dental coverage, like salary and vacation time, is part of your total compensation package. EXERCISE YOUR RIGHT. Discuss your concerns. Voice your preferences. Any reasonable employer will listen.

 

WHAT CAN I DO?

  Read Your Benefits Booklet

Current federal law requires your plan sponsor to provide a full disclosure and description of your benefits package upon your employment or enrollment into the program. READ IT!

 

  Ask Questions

Once you've read your booklet, ask questions on anything you do not understand. If your benefits manager cannot answer your questions, call the insurance company.

 

  Investigate Discrepancies

If you receive payment from an insurance company that is less than you expected, talk to your benefits manager and/or the insurance company about your concerns. You have the right to know how your benefits are calculated.

 

  Know the Facts

Insist on a clear description of your dental coverage. Know the different types (See our brochure, "Just The Facts, Please") and their limitations. To take advantage of your benefits, you may have to stop seeing your family dentist.

 

  Do Your Homework

Insurance companies can create plans that satisfy both your needs and those of your employer. Ask your friends who work in other industries and companies about their benefits. Compare your plan to theirs. Get information about programs you like and pass it along to your benefits manager or your supervisor. Talk to fellow employees about options. A fringe benefit that isn't used because it doesn't meet your needs wastes your employer's money. Speak up!