What should I look for when I buy a dental insurance? Most tricky terms that insurance uses in the contract that can lead to non-payment of services.
- COVERAGE: ALL THINGS ARE COVERED DOESN’T MEAN all things are paid for usually they are covered ONLY AT A PERCENTAGE OR PORTION.
- TERMS AND CONDITIONS ARE VERY CRITICAL – THESE ARE THE THINGS YOU SHOULD NOT HAVE IN YOUR PLAN. IF YOU HAVE IT COST MIGHT BE MORE OR YOU PAY FULL FEES.
- WAITING PERIOD: If you have this it means your procedures are covered only after 6 months to a YEAR. Till then you pay everything out of pocket.
- MISSING TOOTH CLAUSE: It means if you have the teeth extracted or missing tooth and you go and buy the insurance. insurance will not pay for replacing the existing missing teeth (the form of bridge or denture or partial). THIS MEANS IN SIMPLE TERMS PRE-EXISTING CONDITIONS ARE NOT COVERED. (It’s like saying you cant be covered for cancer treatment after the cancer is detected.)
- DOWNGRADE FACTORS. very commonly used fine print by insurance, usually increases you copay amount by at least $10 or more. It indirectly means that they will pay for low-cost similar services that would have similar treatment outcomes or replacing teeth or tooth structure.
- e.g: back teeth silver filling cost portion will be paid by insurance not the white filling. Similarly porcelain or white crowns are not covered on back tooth as they are not visible so
- e.g: if you have missing teeth on both the sides of your mouth, insurance will pay for partial or denture (removable prosthesis) covered usually at 50% which usually comes on average to $500 for insurance portion, as compared to cost of bridge (fixed prosthesis) coverage at 50% that comes to $1000 for each so $2000 in total for bridge on both side.