Below you will find a few of the questions we are frequently asked about Michigan dental insurance at our office. Please refer to Dental Insurance Clauses and Terms for definitions of terms and fine print items.
What is dental insurance?
Dental insurance is not really an insurance plan, it is more of an agreement that will aid in the payment for some of your dental procedures. They generally work this way, the more your employer puts in for the coverage, the less your out-of-pocket expenses will be.
How do dental plans differ from one another?
All dental plans differ in one way or another, whether it be co-payment amounts, deductibles, or excluded services. For a more details on these features, visit our page on Dental Insurance Clauses and Terms.
My plan says it covers 100%, so why did I get a bill?
Most dental plans will cover 100% for a particular service but never for all services. This 100% coverage may also be based of an artificial fee set up by your insurance company and if your dental office charges more than the insurance company expects, you will get the bill for the remaining amount.
My insurance has paid, can you just waive what I owe?
While we would like to help you out in this manner, this can be looked at as falsified billing. Insurance companies audit our records and can prosecute if we do not bill correctly.
Is it possible to change dates and codes for billing, so I can get better coverage?
The insurance companies regularly look at records. All of the information on you, including dates and treatments are truthfully in your record. If a date or code is changed, that is fraud and both you and your dentist can be fined or even imprisoned.
I have already reached my maximum! Is this normal so early?
40 years ago, when the $1000 maximum was set, $1000 was a decent amount of coverage per year. Today, with inflation, the maximum should be somewhere around $5000. However, because businesses want to keep the price of insurance down it hasn’t raised. It is not uncommon that people reach and exceed their yearly maximum.
The treatment I need to have isn’t covered by insurance, but a less expensive one is. Should I choose the less expensive one instead?
It is common that insurance providers will pay for the “least expensive alternative treatment”, however this is not always the best choice. Discussing your options with your dentist is advisable.
My insurance doesn’t cover the procedure my dentist advised, so it must not be a necessary procedure right?
No. Your insurance policy has been designed by lawyers and financial experts who are trying to keep costs down. They do not have any say in what you personally need or want from your dental treatment. Your dentist knows what is best for you, so it is best to talk it over with him.
My insurance said that the dentist has overcharged me. What am I supposed to do now?
Many insurance companies will present their fabricated fees as “reasonable or usual prices” for dental work. However, these fees can be out-dated or unrealistic and based off of how much your employer pays for your insurance. This does not mean that your dentist has over charged you.
Wouldn’t my insurance company save money in the long run if preventative treatment and better alternatives were covered?
On average, employers will change insurance providers every 2 years, so your insurance company is not concerned with what will happen later on down the road. Insurance companies are looking at the profits of now, not the future.
How come my dentist can only give me an estimate of my coverage?
All dentists deal with 100s even 1000s of plans and treatments every year. With the plans changing as often as they do, it’s very difficult for your dentist to stay up to date with each person’s specific plan.
Why do you not send written estimates?
A pre-authorization for service is rarely required by insurance companies. Those services that do require pre-authorizations almost 70% of the time do not get done because of the long drawn out process to get the estimate.
My dental insurance seems unfair. How much is it to change my insurance?
Typically, dental insurance ranges from $30 to $500 a month for family plans. If you are unhappy with your coverage, let your employer know. They may not be aware of exactly what your plan entails, and can switch to a better plan for (sometimes) a very low cost.
My spouse has insurance, how does this affect me?
In the past, dental plans would work together. Today, it is rare to find an occurrence where you get any coverage from a second plan. If this does happen, consider it a gift.
I have medical insurance, will you accept that?
There are only a few situations in which we can accept medical insurance for treatment. A few examples would be accidents or oral surgery
I saw a list of “preferred providers”, how do dentists get on this list?
In order to be put on this list, dental providers are screened for legal violations and malpractice, however, generally speaking they just need to agree to accept a lower reimbursement. Be advised that the lower the dentists compensation is, the less time they will have to work with you and offer you quality care. If the list you find is short, just keep in mind the amount of compromises you may be accepting.
How does your office handle insurance?
Prior to treatment we will ask you to pay your co-payment and once treatment is complete, we will process the paperwork to your insurance company. After your insurance pays, we will either send you a bill or reimburse the difference. Just keep in mind, whatever your insurance does not cover, is your responsibility to pay.
What is the reason for collecting co-payments automatically?
By doing away with some paperwork and administrative costs, we can give you more savings.
Dental insurance seems so complicated. Does it have to be?
No it doesn’t. Many insurance companies are changing to “direct reimbursement plans” which are clear and simple and tend to cut administration fees by around 50%. Many employers do not know about this. If you want more information, please direct them to the American Dental Association (800) 621-8099 x 7746.