Dental Insurance. What You Need to Know

November 16, 2010 by  
Filed under Carrington Dental News & Updates

Dental insurance isn’t really insurance (a payment to cover the cost of a loss) at all. It is actually a money benefit, typically provided by an employer, to help their employees pay for routine dental treatment. The employer buys the plan based on the amount of the benefit and how much the premium costs per month. Most plans are designed to only cover a portion of the total cost. Even if your plan says that it will cover some procedures completely, this is seldom the case. The complete coverage they refer to is usually just what the carrier allows as total payment toward a procedure, not what any dentist may actually charge. So, the amount that will be paid is based on what your employer has negotiated as a benefit for you; tied more to the premium being paid to the insurance carrier rather than the fee for the service you need. Because of this, most patients find that there will be an amount that insurance doesn’t cover, even when they say they are paying 100%. That amount is your responsibility, commonly called your portion.

Most insurance plans specify how many of certain types of procedures they will consider annually. These include “cleanings”, periodontal (gum and bone) treatments, x-rays, and examinations, because these are the types of services that many people regularly need. Since they are “in demand” the carrier wants to limit how many they will cover. If they did not limit their payment toward these procedures, the employer’s premiums would be much higher. A way to think about this might be to compare dental benefits to what is covered under your car insurance. Accidents and damage to the car are typically covered; not replacement of windshield wiper blades, oil changes, or tires. Why is this? Replacement of wiper blades, oil, and tires occur frequently and would be expensive to include in any policy. Damage to a car, less frequently.

If you are wondering about your insurance coverage, a good place to start is the Employee Benefits Coordinator where you work. He will likely have the answers you are looking for. In addition, if you are unhappy with your insurance, or if you feel you are not getting the proper benefits, he is the best person to go to with your concerns. Most employers want their employers to receive the benefits for which they are paying. If the insurance is not paying correctly, they want to know.

Whether your insurance plan pays a little or a lot toward your dental treatment, it helps. However, it is a mistake to let your benefit plan tell you what treatment you should have. Your dentist has the responsibility of recommending treatment you need, your insurance plan has the responsibility of limiting payments to the terms negotiated by the employer.

We base our fees on the basic Manitoba Fee Schedule of the current year.

Call us if you want to know more. We are always happy to help!

  • Brooke Fraser