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Bull Valley Dentistry Answers questions about “Why Your Dental Insurance does not pay for everything

Posted July 25, 2014.

Most insurance companies let you see the dentist of your choice and these plans pay an established percentage of the dentist’s fee…Bull Valley Dentistry accepts all PPO Dental Plans.  Your plan purchaser (most often your employer) makes the final decision on “benefits” with an insurance company of their choice.  Employers can also use the same Insurance companies to offer many different benefit plans to their employees, often offering their management level higher dental benefits, then say their front desk staff.

There is no regulation as to how insurance companies determine reimbursement levels, resulting in wide fluctuation.  In addition, insurance companies are not required to disclose how they determine these levels.  The language used in this process may be inconsistent among carriers and difficult to understand.

Your dental plan may only allow benefits for the least expensive treatment for a condition.  For example, our dentists may recommend a crown, but your insurance may only offer reimbursement for a large filling.  As with other choices in life—such as purchasing medical or automobile insurance, or buying a home—the least expensive alternative is not always the best option.  In this case a “large filling” may crack off the tooth at the base of the tooth, thus leading for the need to have an extraction and perhaps an implant/crown replacement in the long run.

Generally, a dental benefit plan is a contract between your employer, or plan sponsor, and a third party (insurance company).  These contracts vary widely.  There are many ways in which dental plans are designed and how reimbursement levels are determined.  You need to know how your dental plan is designed and its limitations.  Your Dental Plan is designed to SHARE in your dental care costs.  It may NOT cover the total cost of your bill.  Most plans cover between 50 to 80 percent of dental services.

At Bull Valley Dentistry we always call for a list of your Dental Benefits, however this is never a guarantee of payment by the insurance carrier.  This is because plans offered by the same employer or written by the same third party payer can vary according to the contracts involved.  We always encourage our patients to do their own research and call to see what benefits are covered and not covered by their specific plan.    You may not understand a reimbursement level on your bill.  If so, you are not alone! If you have questions regarding your dental plan, we encourage you to contact your employer or insurance company.  Of course we are also  happy to try to help you understand your particular policy.  If you need our help do not hesitate to call Bull Valley Dentistry at 1-815-344-2264.

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