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At Bynes' Falls Dentistry we provide uncompromising quality dentistry. We take extra steps to make sure your visits are as comfortable and pleasant as can possibly be regardless of how you pay your dental bill. There are many misconceptions about dental insurance. Here are some of the most common questions we receive.
1. Why don't you belong to any managed care plans?
It is not financially possible to provide the level of care we do if we joined any of the existing preferred provider or managed care plans. We would have to do away with relaxing gas, use materials of lesser quality, spend less time with you, invest less in newer materials and techniques and compromise our infection control standards. We are not willing to do this.
2. How come you don't know what my insurance covers?
There are so many variations in insurance policies that it is not possible to be familiar with them all. Even within the same company, such as Blue Cross/ Anthem, there may be dozens of different plan benefits according to what your employer has purchased.
3. How can I figure out what my insurance covers?
The best way is to submit a pretreatment plan to your insurance company at the beginning of treatment. We will be happy to do this for you at your request. You should expect an answer in four to eight weeks.
4. There are four people in my family. With a $100 deductible and a yearly maximum of $1000 in benefits per person my insurance doesn't go very far. Why is this?
Dental insurance is not meant to cover your entire bill. Although the premiums you and your employer pay have increased significantly, the maximum yearly allowance hasn't changed in forty years!
5. On my last insurance statement it said your fees are higher than the UCR. What's a UCR?
UCR stands for usual, customary and reasonable. The insurance company calculates this by averaging fees in an area. They then lower the average fee by 20% and call it Customary. Most insurance companies do not recalculate the UCR fees annually. In many cases it is very outdated. It is interesting to note that the insurance companies will not release the data from which they determine the UCR fees. By implying that dentists are overcharging attention is taken away from the fact that insurance benefit payments are lower than what has actually been promised.
6. So what can I expect my insurance to cover?
We find that about 40% of your bill may be covered. Remember that certain procedures may not be covered by your plan at all. Usually these are elective or cosmetic procedures.
7. I had two crowns done and they weren't covered under my plan. Are these elective procedures?
No, they are not. Your employer chooses which plan to purchase. The cheapest plans only partially pay for low fee items and exclude necessary but expensive dental work such as crowns and bridges. Your benefits are determined by how much your employer pays in premiums plus the profit margin of the insurance company. In your case the insurance company may pay for a very large silver filling instead of a crown because they have the option of paying for the least expensive alternative. Unfortunately, the least expensive alternative may not be appropriate or professionally acceptable.
8. You did a chemical treatment of a gum pocket which reduced my pocket in half. It also stopped the bad odor I was getting from my mouth. It was a tenth of the cost of correcting it surgically and was absolutely painless. Yet my insurance company wouldn't pay for it because they never heard of it. What's the deal with that?
We spend a lot of time and money keeping up with the latest developments in dentistry. The insurance companies are not dentists and don't understand some of the latest procedures, many of which save the patient and the insurance company money in the long run. In today's business climate large insurance companies do not take a long term view; they are more interested in the next quarter's profits. Some insurance companies don't even pay for sealants which have been proven to prevent cavities from forming!
9. I don't know much about dental insurance forms and how to fill them out. How do I get reimbursed for my dental work.
Simply provide us with a form that you can obtain from your workplace. You have to fill out information such as name, address, social security number, etc.. You then attach a copy of the super-bill that you got at the end of your appointment and submit it. It's that simple.
10. What do I do if I feel I've been treated unfairly by the insurance company?
The best thing you can do is to complain to your union or your employer. They are the purchasers of the policies and they have the most influence. If that is not effective or if you feel that the insurance company has not honored the contract or is acting fraudulently you should contact the Insurance Commissioner for the State of Connecticut, 153 Market St., Hartford, CT. 06103.
If you have any questions regarding your insurance coverage please direct them to Bobbi. She will do her best to help you get the coverage for which you and your employer have paid.
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