If you are one of the many people who have employer-sponsored dental benefit plans, you are fortunate. Having one of these plans can greatly reduce your dental bill. These plans are arranged by your employer and an insurance company to cover some of your dental expenses. The original idea behind many of these plans was that if employees had regular checkups at the dentist, they would miss fewer days due to dental emergencies, such as abscesses and toothaches. Most dental benefits plans, therefore, cover just enough to get your teeth cleaned twice per year, and perhaps a little more to cover a few fillings or a crown.

Many people think of dental benefit plans the same as medical insurance, but there are many differences. There are almost no dental plans that are comprehensive in coverage, or in other words, cover every dental expense at 100%. The vast majority of plans cover what your employer pays for, not what your dentist recommends. Therefore, your dentist may recommend treatment that exceeds what your dental benefits cover.

Where the confusion often arises is when an insurance provider considers a treatment fee to be more than "the UCR", or "usual, customary and reasonable." Many of these UCR fees are set arbitrarily by the insurance companies and do not reflect what are actual customary fees for the selected services in the area. These pre-set amounts often do not adjust for inflation, and insurance companies are not required to tell you how they determine their UCR's. Considering this, just because your bill shows you were charged for more than the UCR determined by the insurance company does not mean you were overcharged for the procedure.

It is the dentist's responsibility to discuss with you all of your treatment options, even ones that are not well covered by dental benefit plans. It is up to you to decide which treatment option is best. When deciding on treatment, always remember to consider what is best for your long-term health, and try not to be tempted to settle for only what your insurance will pay. As with many things in life, the least expensive option is often not the best one--and it could prove to be more expensive in the long run.

Feel free to ask us options for financing treatment that is beyond what your insurance will cover. You'll find that there are many affordable choices.

Dr. Kim Dr. Kim

Dr. Kim Okamura

I'm Dr. Kim Okamura and this blog is a product of my love of dentistry. I dedicate it to all the patients I have served so that they may better understand my craft. The information here will give you and others the power to maintain and protect one of your most priceless gifts ... your SMILE.