Your dental insurance is based upon a contract between the insurance company and your employer, or you and your insurance company if you have an individual plan. Should questions arise regarding your dental benefits and coverages, you should contact your employer or insurance company directly.
Dental insurance benefits differ greatly from medical health insurance benefits and can vary quite a bit from plan to plan. When dental insurance plans first appeared in the early 1970’s, most plans had a yearly maximum of $1000. Today, some 40+ years later, most plans still have an annual maximum of approximately that same amount. Your premiums have increased but your benefits have not. Therefore, dental insurance was never set up to cover your services 100%; it is only an aid.
You may receive a notification from your insurance company stating that dental fees are “higher than usual and customary”. Insurance companies never reveal how they determine UCR fees (usual, customary and reasonable). The fees are somehow determined by taking a percentage of an average fee for a particular procedure in a geographic area. We do not provide average dentistry, nor do we charge average fees.
Many plans tell their participants that they will be covered “up to 80% or 100%” but do not clearly specify plan fee schedule allowances, annual maximums, or limitations. It is more realistic to expect major dental insurance to cover 35% to 50% of major services.
Many routine dental services are not covered by dental insurance companies. This does not mean they aren’t necessary or appropriate, they are just not covered.