Dental Blog

Here Are 5 Things That Will Help You Maximize Your Benefits

Here Are 5 Things That Will Help You Maximize Your Benefits

Cartoon character holding umbrellaDental insurance is not the great umbrella that it use to be. Insurance companies are in the business of making money and they are very good at it. They often make it difficult to get the benefits that you are entitled to.

Yearly Cleanings

You can only have a cleaning once a year. Have you heard this before? This is usually not the case. Insurance companies do limit some procedures but there are other procedures that you can have several times throughout the year. When you come in for a cleaning, your hygienist will do a variety of procedures.

  1. Prophylaxis – this is the gritty tasting toothpaste
  2. Scaling – this the scraping on the teeth
  3. Fluoride – this is the wonderful tasting mouth rinse
  4. Recall – this is the examination with the dentist
  5. X-rays

The insurance companies will limit the number of times you can have a prophylaxis, fluoride, x-rays or recall. But what they don’t tell you is that you can have several visits of scaling during the year. Some plans will allow up to 16 units or even unlimited units. Since your hygienist will most likely only use 3-4 units at a time, this means you can come back for 4 -5 cleanings during the year. By using this benefit it will help you maintain a healthier mouth and still stay within the insurance companies’ requirements.

We can help you find out how many units you have available, just ask one of the receptionists.

Calendar showing Dec 31Maximums

Most dental plans will have a maximum dollar amount that you can spend during the year, the majority of the plans run the calendar year. The two things they don’t tell you is that -

  1. First - they have restrictions on what procedures that you can spend this money on and how much they will pay out. Insurance companies will say you have $1500 but that is totally dependent on the percentage they pay their fees at and what procedures they will pay for.
  2. Second – If you don’t use it, you lose it and you paid for it. You are not able to carry this amount over to the next year. Unused maximums is just money back in the insurance companies pockets

We can help you figure out your maximums and make sure you are getting the greatest benefit from your plan.

Dollar sign shaped plant growing in potFee guides

This is a very misunderstood principle. Effective January 1, 2018, the dentists of Alberta have a new 2018 fee guide that they can base their fees on. Some insurance companies have not updated their plans accordingly and are often paying lower than the recommended fee guide. They are quick to blame the dentist but this is not the case. Some insurance companies are still paying on 1997 fee guides. The insurance companies also will not provide their fee guides to the public so there is no way of knowing what their complete fees are. We are happy to provide all our fees.

Pre-Determinations

Pre-determinations are a regular part of dealing with an insurance company. There are several things to know when evaluating your preauthorization.

  1. Insurance companies tell patient all the time they must have a predeterminations prior to treatment. This is just a way for the insurance companies to slow down the treatment process. For covered services the insurance companies cannot refuse payment.
  2. A predetermination does not guarantee payment. Most insurance companies do not take into consideration your maximum and will approve treatment even though you have spent all of your money. Make sure to read all of the fine print at the bottom of the preauthorization and consult with the dental office staff.
  3. Insurance companies have several procedures that they will not give pricing on so these items, must have a preauthorization. This process is very long and difficult ex – bridges, implants, orthodontics. These delays will often lead to discouragement on the patient’s part and can sometimes cause the patients to abandon the entire process. This keeps money in the insurance companies’ pockets and leaves you with poor dental health.

Red XPurchased Plans

In the media you will see advertisements for plans that you can purchase on your own. These are designed for families that do not have a company plan. These are very expensive and are often very difficult to deal with and they also have very low maximums and fee guides. Make sure that you are asking the following questions.

  1. What is my maximum, what fee guide are they paying and does this maximum increase with time?
  2. Then compare the cost of your premiums with the cost of benefits that you receive. We recently has a patient who did this and they found that they were paying $1200 in premiums but only had a $600 maximum on their dental plan.

We are more than happy to sit down with you and do a free Dental Insurance Consult, so that you can get the greatest benefit from your Dental Plan.