Salt Lake City Dentist Blog

The Simple Secret to Getting the Most from Your Dental Insurance

Posted by Jonathan Campbell on Sep 24, 2014 3:13:00 PM

Every month you pay for dental insurance. If it comes out of your paycheck, you might not even notice...but you do pay for it.

There is a secret to getting the most from your dental coverage. Since we deal with insurance everyday, we know the secret and can share it with you: You are the boss. The insurance company works for you. You pay them to provide you a benefit. You are their customer. They have an agreement with you to reimburse you for dental expenses, and they have to answer to you for how well they do it. We work for you, too. You pay us to take care of your teeth. You are our customer and patient and we have to answer to you for how well we do. But we don't work for the insurance company, and they don't work for us, which means:

• We can't tell you exactly how much your insurance will pay (but because we see so many patients we can give you a pretty good estimate).

• We can't be sure how much of your benefit is left (but we can help you plan your dental work to minimize your costs).

• We can't tell you why your insurance company makes the decisions it does (but we can provide you with all the information you need to find out).

• We can’t be responsible for your insurance claim (but we can bill your insurance as a service to you).

Three things you can do to get the most from your insurance:

1.Talk to your insurance company. Before you come in, give your insurance company a call. Ask them how much benefit you have left, if there are any waiting periods, and how much your plan pays for preventative, basic, and major work.

2.Talk to us. We can schedule treatment to help you avoid going over your benefit. We can help you get a pre-determination letter showing what your insurance pays for treatment options. We can explain the costs and benefits of those options.

3.Ask questions. If something doesn't make sense to you, ask. You are the boss and are entitled to clear answers.

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Tags: Salt Lake City, Dental Insurance

Do You Have Dual Dental Insurance Coverage? Then it's Free, Right???

Posted by Jonathan Campbell on Jan 13, 2014 7:55:00 AM

If you are covered by two dental plans…
When you are covered by two dental plans this is called "dual coverage." This does not "double" your coverage. However, it may reduce your out-of-pocket costs.
Dual coverage works the same way whether you are covered by two Dental insurance plans of the same company or by two different Dental insurance companies. Your primary dental insurance simply works with the other insurance company (secondary insurance) to coordinate your benefits.
Which plan pays first?
The plans set forth rules to determine which plan pays first, ("primary") and which plan pays afterwards ("secondary"). The general rule is that the plan that covers you as an enrollee is the primary plan and the plan which covers you as a dependent is the secondary plan.
For your children's coverage, generally the primary insurance company is determined by the birthday rule (i.e., coverage of the parent whose birthday —month and day, not year — comes first in the year is considered to be your children's primary coverage). A divorce agreement or other court ruling may supersede the birthday rule.
How dual coverage works
For example, if both of your plans provide two cleanings a year, each with 80 percent coverage, then: You would not be entitled to four cleanings a year. The primary plan pays its benefit as if there is no other insurance The secondary plan will act as a supplement to the primary plan with its payments limited to the lesser of its normal benefit or the patient’s out-of-pocket costs under the primary plan.
Non-duplication of benefits clause
Some dental benefit plans have "non-duplication of benefits" provisions. This means that the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows for that dentist.
For example, if both the primary and secondary carrier pay for the service at 80 percent level but the primary allows $100 and the secondary carrier normally allows $80 for the same treatment, the secondary carrier would not make any additional payment. However, if the primary carrier only pays 50 percent of the dentist’s allowed fee, then the secondary carrier would reduce its payment by the amount paid by the primary plan and pay the difference. In this case, the secondary carrier would pay $14 ($80 x 80 percent - $50 = $14).
However, if the primary insurance plans annual maximum has exhausted all its benefits for the current policy year then the secondary insurance is obligated to pay at the rates outlined by the policy provisions of the secondary insurance plan.
Keep in mind that an insurance company will never guarantee that they will pay anything, even pre-authorizations are only determinations of benefits, no guarantee of payment.
Dual coverage saves money for you and your insurance by sharing the total cost of dental benefits between two carriers. Containing costs is an important part of your Dental insurance(s) plan to keep you smiling.

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Tags: Dentist, Salt Lake City, Dental Insurance

Dental Insurance and December

Posted by Jonathan Campbell on Dec 16, 2013 8:31:00 AM

We're in the middle of our December rush. I don't mean getting ready for Christmas. Once again we have many patients that are trying to take advantage of their dental insurance benefits before the year ends. Most people who have dental insurance have a yearly maximum that is paid by their insurance company. Usually that amount is $1000-2000. If that amount is not used by the end of the year, those benefits are lost. Each October we send a postcard encouraging our patients with untreated dental disease to come in before the end of the year. Our hope is that they will come in October or November. Human nature being what is it is, most patients wait until December to seek dental care. Each year we are unable to accommodate all the requests for appointments.

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Tags: Dentist, Salt Lake City, Dental Insurance

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