Dental Insurance Plans Part II: Your Responsibility

By July 27, 2015 Knowledge Center

By Vishant Nath DMD

The article last month addressed some tips on how to choose the proper dental insurance company for you as well as how to proceed if you are not happy with the company you choose. This article will explain a bit more about your relationship with your dental insurance company and your responsibility in keeping the relationship running smoothly.

The most important thing to remember when it comes to insurance is that you must remain an active participant in the relationship with your insurance company. Even though you may choose a dentist that accepts your insurance plan, you are still responsible for maintaining your relationship with your insurance company. When you enroll with a dental insurance company, you are establishing a direct relationship with that insurance company. This relationship does not involve, or include the provider that you choose. Oftentimes, patients (or in our case, the parents’ of our patients) assume that the provider’s office is engaged in the relationship between the patient (or subscriber) and the insurance company.

There are two main ways for your insurance claims to be filed with your insurance company. Some offices will do this on your behalf. They may take an up front payment from you for procedures not covered by your insurance. They then file the insurance claim for you and wait to be reimbursed directly from your insurance company for the procedures that are covered under your plan.

The other way is for you to file the insurance claim yourself. In this case, the dental office will collect the total amount owed from you up front. You then file the claim with your insurance company and wait to be reimbursed from your insurance company for the procedures that are covered under your plan.

In the first way described, it may seem that you, as a subscriber, are less involved in the process. However, even though you are not filing the claim yourself, you should still be engaged in the process of filing the claim and be knowledgeable about what is being billed to you, versus what is being billed to the insurance company. All of this information should be explained to you by your provider’s office at the time of your child’s appointment.

The bottom line is this: it’s your insurance. You invest in monthly premiums (either directly or as a benefit from your employer). Make the most of your investment by taking part in understanding your insurance. If you do this, you will get much more satisfaction out of the relationship with your insurance company.

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