Monday, May 17, 2010

What does 100%,no deductible mean in a dental policy?

Where it says cleaning it says 100%, no deductible, does that mean they dont cover it? Its from guardian life dental plan

What does 100%,no deductible mean in a dental policy?
You are 100% covered for cleanings. However.... sometimes the dentists fees are different than your insurance companies fees. To clarify...Your insurance company will pay 100% of their fees. If a cleaning and exam totals $150 and your insurance company's fee schedule is the same, you will not have any out of pocket expense. If your dental plan only allows $120 then you will be covered for that amount and will have to pay $30. Usually this is not the case for bi-annual exams and cleanings.

Just make sure that when you make your next appointment for a routine cleaning it is no less than 6 months. Even a day before 6 mo. will cause you to have to pay out of pocket. Dental insurance is very tricky. Most people don't understand that just b/c your insurance company says that you are covered by them 100%, it is 100% of their fees...not the dentists.

Having no deductible is a great thing! This means that you do not have to pay a certain amont before your insurance kicks in.

I hope I didn't confuse insurance can be a nightmare to explain.
Reply:it means the cleaning is covered 100% and there is no deductible or copay means your cleaning is free...they give you two free cleanings a year as preventive maintenance
Reply:it means they cover the cleaning 100% you don,t have to pay anything.........
Reply:It means you are covered 100% without having to pay a deductible. If your Dentist is participating with the plan, they are not legally allowed to bill you above what the insurance co pays. If they do not participate, they are able to bill you for anything you insurance co feels is excessive and will not pay.
Reply:It means they will pay for the cleaning of your teeth in FULL. No money out of your pocket (awesome)
Reply:It means they will pay 100% of their "usual and customary" charges for a routine cleaning.

This can be misleading - first of all because we don't know how they come up with "usual and customary", and secondly because some cleanings are not considered "routine" and are thus subject to deductibles and co-pays.

As to "you get two free cleanings per year", that is misleading as well. Some plans restrict you to once every 6 months TO THE DAY, some will allow three cleanings if "evidence based" reasons exist.

Dental insurance can be one of the most complex and confusing things people deal with. It leads to many misunderstandings between patients and the dental office - with the dental office being blamed for unusual restrictions and clauses in an insurance plan.

It is important for policy-holders to read and understand THEIR OWN plans. The dental office cannot be responsible for being experts on a patient's plan.
Reply:Slight correction...

100% can apply to the "usual and customary" fee profile in your area OR it can apply to a fixed fee schedule that your employer has purchased from the carrier.

For instance, suppose your plan says that it will allow up to $68 for a cleaning and examination and the dentist charges $100. YOUR plan will allow $68 and that's it, unless you have a list of dentists who participate in the plan and are willing to accept the $68 as payment in fool. Oops! I mean "in full." Sorry.

No comments:

Post a Comment

vc .net