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What Your Insurance Company Doesn't Want You To Know

Do you have the game Monopoly or another game that has fake money? If so, go take $1000.00 from it and set it in front of you.

If your employer offers you dental insurance, this is the amount that they’ve provided for you. (Note: some plans offer more or less benefits per year than $1000.00 but this is a good average to use to illustrate.)

There are some restrictions on that $1000.00.:

  1. You can only use it for dental care. Even if you’d rather use it to pay for the latest cell phone or a car, this money is earmarked for your dental care only.
  2. You need to use it by the end of your benefit period. In most cases this is a calendar year, so for the sake of this article, we’ll say by 12/31/17.  If you don’t use the $1000.00, guess who gets to keep it? The insurance company!
  3. In order to use that $1000.00, you need to put up some of your own money as deductible and copayments. (Again, remember, whatever amount you don’t use goes into the insurance company’s pocket.)

There’s probably little you can change if your insurance is provided by your employer—except maybe to educate whoever is in charge of the benefits so that he or she can try to pick the best plan for the most people, with as little money going back to the insurance company as possible.

If you are purchasing your own plan, it is important to look at what you are getting for your money. If you’re paying $600.00 a year ($50.00 a month) for dental insurance to get $1000.00 worth of benefits and you’re using that $1000.00, or close to it, each year, then you’re getting a good deal. However, if you’re paying $600.00 and only using $300.00 worth of benefits, you might be better off to put that $600.00 into a bank account used for dental care. This way, when those rare big dental expenses come, you have a fund to pull from, but often, you’ll still be ahead financially.

Another thing, dental insurance companies don’t want you to know is that each one decides what they’re Usual, Customary, and Reasonable rate (UCR) would be. You would think that the insurance companies would take the fees dentists from a given area submit and average them to get this, right? If that were so, all insurance companies would have very similar UCRs for Lorain County, Ohio. Instead, each seems to have their own method and formula for computing these—and they want you to think your dentist is “the bad guy”.  For example, in mid-2015, the average price for a dental crown was $990.00. (Mine are priced below that average, just in case you wanted to know.) Metlife says the UCR for its PPO dentists is $650.00; Delta Dental says $910.00 is within the UCR. That’s a big difference in what’s considered usual, customary, and reasonable!

For many, it comes as a shock to realize that their insurance company doesn’t have their best interests at heart. I wish I could tell you that it wasn’t so. What I can tell you is that my team and I will do our best to help you best use the dental benefits you have.

Dr. Jennifer Robb is a general dentist with an office located at 1612 Cooper Foster Park Rd., Lorain, OH 44053. She is accepting new patients—give her office a call at 440-960-1940!