Do insurance companies really want to help you?

Through the years Canadians have had opportunities to benefit from employee or personal dental and medical insurance.  How many of those Canadians actually use it to its full potential?  How many Canadians have never had or no longer have insurance benefits?

Canadians have become so dependent upon their insurance benefits that they now allow those companies to dictate what services they can use, saying things like “what my insurance will allow”.  What we need to remember is that insurance companies are just that, “companies”, out to save their bottom line and make a profit each year to better themselves.  Insurance benefits are great if you have them, and you should use them, but it is so important to realize that they are just that, benefits.  For years, especially in the dental field, clients have completed dental work based on what their insurance will cover and not on the recommendation of their dentist or dental hygienist to help improve or maintain their oral health.

Do you see the issue?  The insurance companies have been allowed to dictate too long.  These companies are the ones who developed the dental “fee guide” in order to rope clients in and control what they deem to be appropriate fees.  These fees were not set by the dental profession; they were set by corporate business people who are out to protect their bottom line.  They also try to tell you that a pre-determination should be sent to them so that they can “approve” dental work to be completed.  Great, someone staring at a picture or x-ray gets to decide if they will reimburse you should you choose to have the work completed, but what about the professional looking in your mouth that has recommended this treatment?  That recommendation would not have been made if it were not warranted; these recommendations are based on what we see and how it will affect the health of your mouth.  What we all miss at the bottom of our estimates from insurance companies is the tiny print that indicates they have the right to not pay benefits if they see fit.

If you have dental benefits, use them, you do pay for them.  What is important for you to know is that when we develop a treatment plan for you in our dental office, it is not based on whether you have insurance or not, it is done so on what your mouth needs in order to function properly and be free of disease.  We do not base our fees on what the insurance companies dictate; instead, they are based on the complexity of what is required to be done for you to reach and maintain your optimal oral health.

Here is a list of information you should get from your insurance company so that you can optimize your benefits each year:

  • Yearly dental benefit maximum
  • Basic dental coverage – percent of fee guide
  • Major dental coverage – percent of fee guide
  • Number of scaling/debridement units reimbursed per year
  • Number of exams reimbursed per year/types of exams reimbursed
  • Yearly deductible owed upon first dental office visit of year (per person insured)  to insurance company above your monthly contributions
  • Year of  fee guide the company follows (it is not always the current fee guide)
  • Does the insurance run Jan-Dec or another combination of months
  • What restorative materials are covered, are they current

There are many ways you can maximize your insurance benefits, and as your provider, we will help you get every dime of your owed benefits from them.  With this in mind, don’t let insurance companies dictate what treatment you can and can’t have to be at your optimal oral health and disease free.

By: Jessica Sech RDH