How to Call Your Dental Insurance Carrier
We are happy to assist you with your Dental Insurance. Ifyou desire further clarification about your coverage, some specific benefit, a low payment, claim denial or other issue, we suggest you contact your carrier directly.
Since you are the client, who paid for the benefits, you have more leverage with your carrier than we do. When you call, please have the following available:
1. Doctors Name and NPI # _1962430124___
2. Your insurance card (with your group and account
numbers, & insurance phone # to call)
3.Copy of treatment performed or treatment discussed (with date, tooth numbers
and treatment codes)
4.Copies of insurance response you may be contesting
After you call, we suggest you write down:
1. Date____________ Time_________of your call.
2. Name of associate you spoke to________________________
3. Reason for Insurance action
4. Next steps to resolve the issue(s)
We are happy to assist you with your Dental Insurance. Ifyou desire further clarification about your coverage, some specific benefit, a low payment, claim denial or other issue, we suggest you contact your carrier directly.
Since you are the client, who paid for the benefits, you have more leverage with your carrier than we do. When you call, please have the following available:
1. Doctors Name and NPI # _1962430124___
2. Your insurance card (with your group and account
numbers, & insurance phone # to call)
3.Copy of treatment performed or treatment discussed (with date, tooth numbers
and treatment codes)
4.Copies of insurance response you may be contesting
After you call, we suggest you write down:
1. Date____________ Time_________of your call.
2. Name of associate you spoke to________________________
3. Reason for Insurance action
4. Next steps to resolve the issue(s)
The intent of all dental insurance plans is the same: to help pay a portion of the cost of dental care.
Sorting through the complexities of different insurance plans, however, can be difficult. Ultimately, patients are responsible for knowing what their individual coverage is. Plan sponsors (usually the employer) are required to provide information detailing what is and what is not covered. Keep in mind that most plans limit the yearly dollar amount that will be paid. |
What should I do if I have a concern or complaint about my dental plan?
Dental benefit plans are the result of a contract between your employer and the insurance company. Your dentist often cannot answer specific questions about your dental benefit or predict what your level of coverage will be because plans vary according to these contracts. Therefore, your concerns should be directed to your employer (usually the human resource department or benefits manager) or plan sponsor (insurance company). |
Insurance Facts:
We often cannot answer specific questions about your dental benefits or predict what your level of coverage will be because plans vary according to these contracts and we deal with over 875 different insurance plans. Therefore, your concerns should be directed to your employer (usually the human resource department or benefits manager) or plan sponsor (insurance company) to get the most benefit from your insurance benefits, it is your responsibility to know your coverage. Keep in mind that most plans limit the yearly dollar amount that will be paid.
Three types of dental benefit plans currently exist:
Traditional or "fee-for-service" plans allow patients to seek care from the general dentist or specialist of their choice. Traditional plans provide benefits based upon either a fee schedule or percentage of what the insurer determines to be usual, customary, and reasonable (UCR) fees. For example: most periodontal services are reimbursed at between 50 to 80% of the UCR fee. In addition, patients may be responsible for the difference between the UCR fee and the dental office's regular fee.
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In a direct reimbursement plan, the patient pays the dental bill and submits the receipt to the employer for reimbursement. There are usually no restrictions other than the limitation on the total dollar amount will be paid.
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Managed-care plans restrict your choice of dentists; they will only pay maximum benefits if the services are provided by a dentist in their plan. Like traditional plans they may limit the type and frequency of care and require the patient to pay the difference between the coverage amount and the dentists’ fee.
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Regardless of the type of plan you have there are a number of terms you should familiarize with including:
It's also a good idea to check if the plan has a "freedom of choice" or "point-of- service" option. These enable you to seek care from a practitioner of your choice. Under most plans you will not receive the benefits if you select a practitioner not associated with the plan. Otherwise, you can always go to the dentist of your choice if you are willing to pay your self.
If a plan doesn't cover a procedure that is recommended by Dr. Spainhower, this doesn't mean that the treatment isn't needed; it only means that the procedure falls outside of the scope of coverage included in your plan. Limitations in coverage are the result of financial commitment your plan sponsor or employer has agreed to make and the benefits the insurance company will offer in exchange for that commitment. Please remember the treatment covered by your plan is in no way related to your health needs.
Insurance companies are not looking out for your best health; they are just there to help you foot the bill. We all need to work together to understand the limitations insurance companies put on our benefits and work to address unfair practices.
- Deductible - the amount you pay personally before the insurance plan kicks in
- Copayment - your share of the financial responsibility for a specific dental service
- Limitations - such as waiting periods before coverage begins
- Exclusions - treatments not covered such as implants or pre-existing conditions
- Annual or lifetime maximum - benefit dollar limit of the insurers financial responsibility
It's also a good idea to check if the plan has a "freedom of choice" or "point-of- service" option. These enable you to seek care from a practitioner of your choice. Under most plans you will not receive the benefits if you select a practitioner not associated with the plan. Otherwise, you can always go to the dentist of your choice if you are willing to pay your self.
If a plan doesn't cover a procedure that is recommended by Dr. Spainhower, this doesn't mean that the treatment isn't needed; it only means that the procedure falls outside of the scope of coverage included in your plan. Limitations in coverage are the result of financial commitment your plan sponsor or employer has agreed to make and the benefits the insurance company will offer in exchange for that commitment. Please remember the treatment covered by your plan is in no way related to your health needs.
Insurance companies are not looking out for your best health; they are just there to help you foot the bill. We all need to work together to understand the limitations insurance companies put on our benefits and work to address unfair practices.