Dental Insurance Can Change Without Warning
What if your dental insurance company left you with a $215 bill you never expected? This happened to a family that lives in Troy and we wanted to share their experience to help other families avoid the same problem. Mom brought in her 8 year old daughter for a regular checkup and we recommended that she return for 4 sealants, 1 filling and a growth & development xray. Total fee of $392. We estimated the insurance (Delta Dental) to cover most of this amount. Mom felt good about this estimate because her daughter had a sealant before and the same size filling as well (both 3 years before).
When the insurance paid, they paid on everything – but at such low amounts that Mom ended up with about $215 that she did not expect. For example, our fee for a sealant is $42. The Delta dental insurance policy reads that they will pay 85% for sealants. Mom expected that insurance would cover $36 ($42 x 85%). However, their top fee for a sealant is $15 – so they ended up paying only $13!
This is a very sneaky way of reducing benefits. Nothing in the policy let this family know that the dental benefits had changed. Nobody in HR told them of any changes. The percentages of coverage did not change. The only thing that changed was the Delta top fee they would pay for each procedure.
My normal response is to encourage the family to talk with their HR person. In this case, the company is a supplier to the auto industry and has reduced their employee size from 350 to only 50 people left. The Mom I was working with said that she didn’t even know if the HR person still worked there!
So, it sounded like a situation where the company was having financial troubles and one of their decisions was to reduce the dental insurance plan benefits. However they did this in a way that none of the employees knew about – and so this family ended up with a large bill they never expected.
The Mom and I came to an agreement – she is appealing the Delta Dental insurance payment and to help out, we adjusted off half her bill ($107 value). Part of the letter she has submitted to Delta reads that Delta “does not make adequate information available to the service provider to obtain an accurate estimate. This is a serious disservice to the subscriber and patient.”
So – if you have dental insurance and your company is having financial trouble, please ask for a pre-treatment estimate for ANY visit. We are happy to send these requests to your dental insurance company on your behalf, free of charge – and if we can help you avoid a nasty surprise, like owing an extra $215, we will do everything we can to help. In fact, if you are in management for a company that is struggling to maintain a dental benefit, please call me – I can help a company to maintain dental benefits, while saving the company money and avoiding nasty surprises to employees.
Hope this was helpful.
Jill Nesbitt, Office Manager 937-667-2417
What if your dental insurance company left you with a $215 bill you never expected? This happened to a family that lives in Troy and we wanted to share their experience to help other families avoid the same problem. Mom brought in her 8 year old daughter for a regular checkup and we recommended that she return for 4 sealants, 1 filling and a growth & development xray. Total fee of $392. We estimated the insurance (Delta Dental) to cover most of this amount. Mom felt good about this estimate because her daughter had a sealant before and the same size filling as well (both 3 years before).
When the insurance paid, they paid on everything – but at such low amounts that Mom ended up with about $215 that she did not expect. For example, our fee for a sealant is $42. The Delta dental insurance policy reads that they will pay 85% for sealants. Mom expected that insurance would cover $36 ($42 x 85%). However, their top fee for a sealant is $15 – so they ended up paying only $13!
This is a very sneaky way of reducing benefits. Nothing in the policy let this family know that the dental benefits had changed. Nobody in HR told them of any changes. The percentages of coverage did not change. The only thing that changed was the Delta top fee they would pay for each procedure.
My normal response is to encourage the family to talk with their HR person. In this case, the company is a supplier to the auto industry and has reduced their employee size from 350 to only 50 people left. The Mom I was working with said that she didn’t even know if the HR person still worked there!
So, it sounded like a situation where the company was having financial troubles and one of their decisions was to reduce the dental insurance plan benefits. However they did this in a way that none of the employees knew about – and so this family ended up with a large bill they never expected.
The Mom and I came to an agreement – she is appealing the Delta Dental insurance payment and to help out, we adjusted off half her bill ($107 value). Part of the letter she has submitted to Delta reads that Delta “does not make adequate information available to the service provider to obtain an accurate estimate. This is a serious disservice to the subscriber and patient.”
So – if you have dental insurance and your company is having financial trouble, please ask for a pre-treatment estimate for ANY visit. We are happy to send these requests to your dental insurance company on your behalf, free of charge – and if we can help you avoid a nasty surprise, like owing an extra $215, we will do everything we can to help. In fact, if you are in management for a company that is struggling to maintain a dental benefit, please call me – I can help a company to maintain dental benefits, while saving the company money and avoiding nasty surprises to employees.
Hope this was helpful.
Jill Nesbitt, Office Manager 937-667-2417
posted by HealthPark Dentistry @ 3:32 PM
1 comments
1 Comments:
Jill, that won't work. I switched insurance providers and dentists with my employer plan in January. When I went for my first visit, the new dentist did send in a pre-treatment estimate, got verbal AND faxed approval for the work I needed done - which included a panoramic xray. Well after the work was done, Delta is denying the payment because they said I had a panoramic done within the past 3 years with ANOTHER insurance company and their policy is to only pay every 3 years. Well I pointed out that they've never paid for one for me and they said I'll have to appeal. And I pointed out that I had verbal and written confirmation that they would pay and they just said "appeal us." So right now I'm appealing but I will never knowingly choose Delta as a provider again
Candy Bowen
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