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Tooth Talk with Dr. T: Dental Insurance

Published: Nov. 4, 2020 at 7:47 AM CST
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ROCKFORD, Ill. (WIFR) - Tooth Talk with Dr. T: Dental Insurance

Good morning, I’m Dr. Kris Tumilowicz at Edgebrook Center. Today we are talking about dental insurance. Oh boy, it’s November already and I still havent used my insurance. Dental insurance can be confusing. And to make matters worse, every insurance plan handles things differently. Dental insurance plans are a contract between you and your insurance provider. It’s important that you read your insurance policy or talk to your insurance representative, so you can understand how your plan helps pay for dental treatment. Some plans pay only for dentists who belong to the plan’s network, while others let you see the dentist of your choice. To determine how much they’ll pay for dental treatment, insurance plans use several methods. One of them is called the Table of Allowances in which the plan lists the treatments it will pay for

and the amount it’ll pay for each. Another very common method is called UCR. This stands for “usual, customary, and reasonable.” In these cases, the plan calculates the maximum amount allowed for a particular treatment, and then pays 50 to 80 percent of that amount. You pay 20 to 50 percent of the remaining UCR fees, plus the difference between the actual cost of the treatment and insurance plan’s UCR fees. Most people assume that insurance companies base their fees on statistics. But, while statistics are gathered, insurance companies are not required to use them, and sometimes the statistics are out of date. This means that the insurance plan’s UCR fees are usually not representative of what local dentists actually charge. In fact, different insurance companies' dental plans often have a different set of UCR fees for the same geographical area and for the same group of dentists. And it’s not unusual for the same insurance company to pay different UCR fees to the same dental office, depending on which of the company’s plans the patient is enrolled in. You should also know that most insurance plans have not kept up with advances in dentistry. They may cover only minimum quality materials and services and exclude treatment they can label as “discretionary,” even common treatments such as implants, white fillings, bonding, fluoride treatments, and some periodontal care. In addition, dental coverage maximums haven’t kept up with the times. Back in 1960, a typical annual maximum benefit was $1000. These days, many plans still offer that same maximum, but to stay up with inflation, that $1000 in 1960 would have had to increase to more than $6500 today. This is why it’s very common for patients to choose dental treatment that their dental insurance plan won’t fully pay for. Even though most plans pay for only basic services, we believe that you should be able to choose the most appropriate dental treatment for you and your family. So dental insurance can be great or average, but you should take advantage of it mmake sure you call your dentist soon to use your insurance before the year is up

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