Dental payment plans and Understanding your dental insurance

Remember, it is a mistake to let benefits be your sole consideration when you determine what you want to do about your dental condition.

Why doesn’t my insurance cover all the costs for my dental treatment?

Dental insurance isn’t really insurance (a payment to cover the cost of a loss) at all. Dental insurance is actually a money benefit typically provided by an employer to help their employees pay for routine dental treatment. The employer buys a plan based on the amount of the benefit and how much the premium costs per month. Most benefit plans are only designed to cover a portion of the total cost, which is why our dentist in Lincoln, NE offers payment plans.

But my plan says that my exams and certain procedures are covered at 100%.

Many carriers refer to their allowed payments as UCR, which stands for usual, customary and reasonable. However, usual, customary and reasonable does not really mean what you might think it does. UCR is a listing of payments for all covered procedures negotiated by your employer and the insurance company. This listing pertains to the cost of the premiums and where you are located in your city and state. Your employer has likely selected and allowed payment or UCR payment that corresponds to the premium cost they desire. UCR payments could be accurately called negotiated payments. Contact us if you still have questions. We understand insurance can be hard to understand and our team of dental professionals at Northeast Lincoln Family Dentistry is her to help.

Since most payments are negotiated, does this mean that there is always a balance left for me to pay?

Typically there is always a portion that your benefit plan will not cover. But, don’t let that deter you from seeing a dentist in Lincoln, NE.

I received an Explanation of Benefits from my insurance carrier that says my dental bill exceeded the usual and customary. Does this mean that my dentist is charging more than he or she should?

It does not mean that your dentist in Lincoln, NE is charging too much. Remember that what insurance carriers call UCR is really just what your employer and the insurance company have negotiated as the amount that will be paid toward your treatment. It is usually much less than what any dentist in your area might actually charge for a dental procedure.

Why is there an annual maximum on my benefits?

Maximums limit what a carrier has to cover each year. Amazingly, despite the fact that costs have steadily increased, annual maximum levels for dental care not changed since the 1960’s.

Why do some benefit plans require me to select a dentist from a list?

Usually a dentist on the list has agreed to a contract with the benefit plan. These contracts have restrictions and requirements. If you choose a dentist on the list, you typically pay less toward your dental care than if you choose a dentist not on the list. If your dentist is not on the list this does not mean that something is wrong with the dentist or a particular dental office. 

Why does my dental plan only pay toward the least expensive alternative treatment?

To save money. If your dentist recommends a crown, but your insurance only offers benefits toward a filling, this does not mean that a filling is all that can be done or that a filling is the best option. In short, it just means you’ll need to pay a little more should you choose a crown. Remember your dentist’s responsibility is to prescribe what’s best and the insurance carrier’s responsibility is to control payments. If you, like many others, prefer to go a different route than your insurance company will pay for, inquire about dental payment plans with a dentist near me in Lincoln, NE. Dental payment plans are an excellent option for allowing you to get the treatment you need.

What should I do if my insurance does not pay for treatment I think should be covered?

Because your insurance coverage is between you, your employer and the insurance carrier, your dentist does not have the power to make your plan pay. If your insurance does not pay, you are responsible for the total cost of treatment. The Employee Benefits Coordinator at your place of employment may also be able to help. Complaints can be lodged with the state Insurance Commission.

Why can you only estimate my coverage?

Dentists deal with thousands of plans and hundreds of types of treatments each year. Most carriers refuse to release the details of their plans and many times change policies and reimbursements amounts without notice. Our dentist in Lincoln, NE understands your concern for cost and we we will do our best to get your estimate as close as possible. As with any insurance coverage, however do know that plan payment is not guaranteed until your claim has been received and therefore, there is a chance our estimate could change based on what your insurance plan decides to pay.