Insurance

"Help me understand some of the points concerning my insurance." Or- Just the facts, ma'am (or sir), just the facts!
Almost all insurance plans offer between $1,000/$1500 of benefit per year. They determine what they will pay per procedure by what is called "usual & customary". After the "usual & customary" is established, they pay a predetermined percentage (%) of this fee, after a "co-pay" amount has first been paid by the patient.

Would you like to hear the "rest of the story?"
The total benefit paid out per year by insurance companies is exactly the same amount they paid 30+ years ago! Inflation, cost of living increases, etc don't apply to your dental benefit. The actual "value" of your benefit is about ΒΌ of what you might have received in the '70's. Your employer, who provides the benefit, is paying about a 3 times larger premium than in the 70's!

The "usual customary" is not the average prevailing fee for a procedure(s) in the area and does not take into consideration the type & quality of materials used, care, or skill & judgment of the clinician. It is an arbitrarily determined figure set low by your insurance provider.

How are the percentages (%) paid, determined?
It is a negotiated figure chosen by the insurance company! (And agreed upon, by your employer). The insurance company is not in business to make sure you are well cared for, or safeguard your best dental interests. Their business is interested in only two things: 1) Collect premiums from your employer and 2) Pay out as little of the premium collected as possible per year.

*At Reconstructive & Cosmetic Dentistry of Greater Lafayette, we pledge to fight for your proper care & benefits and will do our best to get the reimbursement for the care you deserve and to which you are entitled!