Facts About Dental Insurance
Alpharetta dentist Dr. Robert O'Donnell and Team want to help you and your family get the best possible coverage from those hard-earned dental insurance benefits.
Dental insurance plans have their own unique terminology, along with complex terms and conditions. We will do our best to obtain as much information as possible about your dental insurance benefits to help you make financial decisions about your care. There are a few common facts about insurance that apply to most dental insurance plans:
Most dental insurance plans are a business arrangement between an insurance company and an employer. It is important to remember that reimbursement and benefit levels are based on carrier and employer business decisions and not on an individual's need for treatment.
Dental insurance plans are designed to pay only a portion of your dental health expenses. Dental plan maximum benefits average $1,000 to $2,500 per year;
Dental insurance maximum amounts have not changed in the past decade, while the cost of living has increased dramatically.
Premiums for dental insurance coverage average approximately $50-75 per month for an individual. If these funds were set aside in a health savings plan, this would total $600-900 per year that could be used for both dental and medical needs, without exclusions or limitations on how it is spent.
Patients with extensive treatment needs or active dental infection are not able to spread their dental procedures over multiple insurance benefit years; this would increase the risk of tooth loss and dental pain.
The majority of dental insurance plans do not include coverage for cosmetic treatments, such as teeth whitening or veneers. Many have age or frequency limitations, such as for fluoride treatments or dental sealants.
Dental insurance plans often have a ‘missing tooth clause’. This type of plan would not cover tooth replacement procedures, such as bridges, partial dentures, full dentures or dental implants.
Frequently dental insurance plans will apply ‘alternate benefits’ towards a service, such as paying for silver fillings rather than tooth-colored fillings, or, not covering major restorative services, such as a dental crowns or CEREC® restorations, and will pay a lesser amount for regular fillings instead.
Dental plans use the terms ‘usual, customary and reasonable’ (UCR) to determine insurance benefits. This term applies to a formula that each dental insurance carrier uses to set reimbursement levels across the country. Each insurance carrier has a different UCR schedule; the criteria upon which this formula is based, such as region, time intervals, type of dentist is not normally disclosed to the subscriber.
Dr. Robert O'Donnell and Team are committed to your dental health, regardless of your insurance status. Our Alpharetta dental team is happy to answer any questions you may have about dental insurance, please Contact Us to learn more about how dental insurance works.