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Insurance at Bihary Family Dental


Affordable Dental Coverage at Bihary Family Dental in Altoona, PA

  • Aetna
  • Ameritas
  • Assurant
  • BC/BS
  • Cigna
  • Delta Dental
  • Guardian
  • Highmark
  • Humana
  • Loomis
  • Met Life
  • Tri Care
  • United Concordia
  • UPMC & UPMC for Life only

How Do I Get the Most Out of My Dental Benefits?

This is a common question among dental patients. We have taken information gathered by the American Dental Association on this topic and hope that you find it helpful in understanding more about your dental benefits.

If your employer offers dental insurance, consider yourself fortunate. This benefit works like a valuable “coupon” that can greatly reduce the costs of dental care. However, no dental benefit plan is set up to cover all of your costs.

To avoid surprises on your dental bill, it is important to understand what your insurance will cover, and what you will need to cover some other way. Dental benefits should not be confused with the dental services you need, which are determined by you and your dentist.

How Do Most Dental Plans Work?

Almost all dental plans are the result of a contract between your employer and insurance company. Your employer agrees upon the amount your plan pays with the insurer.

Your dental coverage is not based on what you need or what your dentist recommends. It is based on how much your employer pays into the plan. Employers generally choose to cover some, but not all, of employees’ dental costs. If you are not satisfied with the coverage provided by your insurance, let your employer know.

Explain the Role of the Dental Office

Your dentist’s main goal is to help you take good care of your teeth. Many offices will file claims with your insurance company as a service to you. The portion of the bill not covered by insurance is your responsibility. Many practices offer financing plans or other ways to help you pay your part of the bill.

Helpful Definitions of Insurance Terms

Key terms used to describe the features of a dental plan may include the following:

UCR (Usual, Customary, and Reasonable) – Usual, customary and reasonable charges (UCR) are the maximum amounts that will be covered by the plan. Although these terms make it sound like a UCR charge is a kind of standard rate for dental care, this is not the case. The terms “usual,” “customary” and “reasonable” are misleading for several reasons:

  • UCR charges often do not reflect what dentists “usually” charge in a given area.
    Insurance companies can set whatever they want for UCR charges. They are not required to match actual fees charged by dentists.
  • A company’s UCR amounts may stay the same for many years; they do not have to keep up with inflation, for example.
  • Insurance companies are not required to say how they set their UCR rates. Each company has its own formula.
  • So if your dental bill is higher than the UCR, it does not mean your dentist has charged too much for the procedure. It could mean your insurance company has not updated its UCRs, or the data used to set UCRs is taken from areas of your state that are not similar to your community.

Annual Maximums – This is the largest dollar amount a dental plan will pay during the year. Your employer makes the final decision on maximum levels of payment through the contract with the insurance company. You are expected to pay copayments, as well as any costs above the annual maximum. Annual maximums are not always updated to keep up with the costs of dental care. If the annual maximum of your plan is too low to meet your needs, ask your employer to look into plans with higher annual maximums.

Preferred Providers – The plan may want you to choose dental care from a list of its preferred providers (dentists who have a contract with the dental benefit plan). The term “preferred” has nothing to do with the patient’s personal choice of a dentist; it refers to the insurance company’s choices. If you choose to receive dental care from outside the preferred provider group, you may have higher out-of-pocket costs. Inform yourself about your plan’s methods for paying both in-and out-of network dentists.

Pre-existing Conditions – A dental plan may not cover conditions that existed before you enrolled for the plan. For example, benefits will not be paid for replacing a tooth that was missing before the effective date of coverage. Even though your plan may not cover certain conditions, treatment may still be necessary to maintain your oral health.

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