Understanding Your Benefits and Insurance

Open enrollment is ending at most major employers, and whether you're experiencing a change in plans this year or not, chances are you still have questions.

The most common misconception about employer sponsored plans is the assumption that all offerings are for (health/dental/vision/life) insurance. Unfortunately, this is not the case. Many coverage plans are not insurance, but benefit and in some cases, discount plans. This means that should the need arise for care, you are not necessarily insured, but can utilize a benefit amount (consider it an allowance for care that is exhaustible) or are eligible for a discount on services from many providers.

Traditional insurance contains detailed descriptions of what is covered and exactly how it is covered. While there is often a benefit to seeing an "in network" provider, often times large insurance companies still offer exceptional benefits to employees who choose to be patients of providers who are not  "in network." This is important because while HMO's of days past dictated who patients could see for care, modern benefits for "out of network" providers mean you may never need to change your doctor. While you may incur minimal out of pocket costs, not having to change your provider means you can develop a good relationship and receive even better care. Below is information you need to know about traditional insurance.

What you should know:

1.       Insurance coverage is a contractual agreement between a patient and the insurance company, not with Dr. Dooley or any other care provider.

2.       Dr. Dooley is happy to file claims on your behalf, the patient. However, it is your responsibility to monitor the details of the coverage and claim status with the insurance company.

3.       It is customary for insurance companies to pay out dental benefits on a monthly or quarterly basis. This means that should your insurance end or change for any reason, before treatment has ended, the remaining insurance balance is your responsibility.

4.       Any Information obtained from your insurance company by an employee o Dr. Dooley is not a guarantee of payment. If for any reason an insurance company pays less than the estimated benefit, you will be held responsible for the balance.

5.       It is the patient’s responsibility to provide Dr. Dooley with any changes in insurance coverage within 10 days of the change.

If you are unaware of your Dental Insurance benefits, please call the number on the back of your insurance are or the personnel department for your employer and ask the following questions.

1.       Has our policy taken effect?

2.       What are our benefits? Can you explain dental co-pays to me?

3.       Is there a waiting period for any specific treatment?

4.       What is the mailing address for claims?

If you have any other questions about insurance coverage, or would like us to investigate your personal plan, don't hesitate to ask. We are always willing to help you better understand your health care options!