I’m Back!! After taking some time off in July, I am back in the office and ready to continue with more information about dental insurance. I will touch on some misunderstood areas in the next few blogs so I hope you will find it helpful. As always, we welcome questions and will do the best to help you understand your insurance policy.
Most dental programs have an annual dollar maximum. This is the maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period. The plan purchaser/employer makes the final decision on “maximum levels” of reimbursement through the contract with the insurance company. The patient is usually responsible for paying costs above the annual maximum. Even though the cost of dental care ahs significantly increased over the years, the maximum levels of insurance reimbursements have remained the same since the late 1960’s. Your employer may want to research plans that offer higher maximums.
Plan Frequency Limitations
Certain procedures may simply not be covered as often as necessary for optimal oral health. A common example might be a plan that pays for tooth cleaning only twice a year even though a particular patient may require cleaning every three months. Other plans, for instance, will only pay for sealants once in a lifetime, when generally sealants only last between 5 and 10 years. Another example is that most plans will pay for 2 exams per year, no matter what kind of exam it is and whether you were seen in another office. Limitation may vary depending on the contract purchased. Limitations in coverage are the result of the financial commitment the plan sponsor has agreed to make and the benefits the third-party payer will offer for that commitment.