Dental Insurance Confusing?
Ever been confused by Dental insurance? What's covered and what's not?
Insurance companies often promote policies that claim to cover specific services, but it's crucial to understand that they tend to disqualify most of the situations in which you might actually need those services. Take, for example, a policy that covers implants but excludes cases where a tooth has been extracted. It's rare to require an implant without a prior extraction, making such coverage seem counterintuitive.
In this video, Dr. Jean explains that dental insurance plans may not always cover procedures as expected. Dental insurance companies have their own criteria and exclusions, leading to potential denials of coverage, even when dentists recommend procedures based on widely accepted professional opinions. Dr. Jean advises patients to be prepared and educated consumers of both dentistry and dental insurance, emphasizing that pre-authorization doesn't guarantee coverage. The goal is to help patients understand the complexities of dental insurance plans and make informed decisions about their dental care.
What Happens when coverage is denied?
This patient was in a catostrophic accident that broke his back and left him paralized. His dental injuries and needs were postponed because he was fighting for survival.
He was finally able to address his dental needs and his claims were repeatedly denied. The insurance company claimed that they did not recieve the appropriate information. We produdced emails faxes and even recorded phone calls confrming that they had the correct information from us.
This strategy of delay and denial lasted two years and escalated to the department of insurance. They did have to pay the claim. This cost several man hours to collect on behalf of this patient. They were caught lying and their penalty was 60 cents interest.
Our intention in sharing this story is not to bring you down but to empower you to become a well-informed and proactive consumer, both in the realm of dentistry and dental insurance.
If you're navigating the complexities of dental insurance or have questions about your dental care, don't hesitate to reach out to us today. We're here to guide you toward making the best choices for your oral health. Sending you healthy vibes!