Many of you have asked us “I no longer have dental insurance provided for me. Can I buy my own insurance?”
Our incredibly skilled and caring office manager, Pia, has written today’s blog to answer your questions . I hope you find it informative and helpful! — Dr. Mark Langberg
Hi everyone!
This blog is about dental “Insurance”, that subject that fills you with uncertainty when you come up to my desk at the end of your appointment. Your employer, management, or union has purchased dental insurance coverage from a selection of plans offered by an insurance company or broker. The type of dental benefits that are covered relate to the dollar amount spent on your premiums, not the urgency or necessity of your dental/medical needs. Generally, the more money spent on a plan, the more services are covered. Most dental insurance covers only 50% to 80% of the cost of treatment. There is almost always co-payment and many times a yearly deductable. There is also always a yearly maximum benefit amount that caps their obligation to you, and it is usually low so the insurance company is assured a profit. So you should think of dental insurance as simply a “subsidy” that helps pay for your necessary dental care, but not the “free ride” the way we all think it should be.
Our mission is to enable you to have the best possible oral and general health. Insurance companies, by their nature, can only stay in business if they pay out less in benefits than they receive in premiums, so by design, treatment for your particular needs may or may not fall within the limits set by your particular dental plan. We cannot permit the insurance company to tell us how to treat you since many necessary dental procedures may not even be listed in your insurance’s procedure/payment schedule.
We recommend to you those treatments that we are certain you need and we will discuss alternative plans with you. Whether or not the recommended treatment is a covered dental benefit is between you and your employer and the insurance carrier. Of course, you are ultimately responsible for paying the entire fee for an accepted dental treatment, regardless of your insurance coverage.
We are happy to arrange for you receive the maximum benefits you are allowed from your dental coverage. There are three things we cannot do:
- Alter the date of treatment;
- Submit a claim for more than the actual fee;
- Submit a claim for procedures that have not been performed.
Our office cannot negotiate with your insurance company for reimbursement of dental expenses. Only the purchaser of the plan (you or your employer) can negotiate better coverage. If you would like better or more coverage, you will need to talk with your plan purchaser about the features you want in your dental plan.
You may not be aware that nowadays most insurance companies do offer “self-pay” insurance products which you can purchase on your own so you do not need to rely on your employer. The cost per year compared to a emergency root canal and crown can be very competitive. Remember, routine dental care in not expensive: it’s the unforeseen emergency that will always costs more than expected. Be aware, however, that most insurance companies will have “waiting periods” or exclusions that mean you will pay premiums for a year or more before certain higher cost procedures (such as crowns) will be covered. There is always “fine print” that you need to read! So that there are no surprises, please call me at 248-356-8790 and I will be happy to help you decipher and clarify this with any plan you may be considering!
Below please find the telephone numbers of the most popular dental insurances used in Michigan. Please remember to retain your patient choice of care and the choice of doctor, stay with in the “Premium or Traditional Dental Networks”. If you choose PPO, Point of Service or In-Network plans, you will have limits on WHERE you can go and WHAT you can have done!
Delta Dental Premier 800-971-4108
Blue Cross and Blue Shield Traditional 800-637-2227
Met Life Tradtional 800-638-5433
Cigna Dental 800-244-6224
So till next time,
Pia, your “Girl Friday”