Dental Insurance is NOT meant to be a PAY-ALL. It is only meant to assist you in the payment of your dental care.
Many routine dental services are NOT covered and are excluded or limited by the policy description. These services, when recommended, are necessary for your treatment and well-being. They should NOT be interpreted as “unnecessary” because the insurance company does not provide a benefit for them.
Many plans state that you will be covered “up to 50%, 80%, or 100%”. In spite of what you are told, we have found in actuality that many plans cover less than that depending on their own established fee schedule. The benefits your plan pays are largely determined by how much your employer/union is willing to pay for the plan. The less they pay for the insurance plan, the fewer benefits you will receive.
Insurance companies establish “Usual and Customary” fee schedules that may or may not have an accurate relationship to what are the “Usual and Customary” fees where you live. Insurance companies often will tell their members that their provider’s fees are “above what is usual and customary” rather than say, “Our benefits are low”. This may be because there are various ways insurance companies establish their usual and customary fee schedules.
In fact, frequently different insurance companies in the same geographical area will have different usual and customary fees. Our fees may be within one company’s usual and customary fees and not another insurance company.