It takes a long time to go over the information that an insurance company sends to you about your policy. The wording can be very confusing, and you will want to make sure that you have a good understanding about it before you make your first dental appointment. So far, I’m rather surprised by some of the information that I have learned about my policy.
Today, I learned that my dentist is not actually considered to be a “Participating Dentist” according to my insurance company. This is greatly disappointing. It means that if I choose to receive treatment from my current dentist, I will be expected to pay out of pocket costs.
The booklet from the insurer says more about what happens if I choose to see my current dentist. There is a small paragraph that is titled “Non-Participating Dentists”. It says:
“We will pay benefits at the Non-Participating Dentist payment rate if Covered Services are provided by a Non-Participating Dentist. The protected balance billing feature does not apply to services provided by Non-Participating Dentists. A Non-Participating Dentist can charge their usual billed charges for services rendered.”
As far as I can tell, I think this means that it is going to cost me more to visit my current dentist than it would be to find a new one. If I find one that is considered to be a “Participating Dentist”, the insurer would pay 100% of the covered expense. They only will pay 80% for a visit to a “Non-Participating Dentist”. They will pay 80% of fillings that “Participating Dentist” puts in, but only 60% of the costs from a “Non-Participating Dentist”.
It is a little intimidating to think about trying to find a new dentist. In the past, new dentists would want to immediately rip out all the previous dental work that is in my mouth, and replace it with their own work. If so, then it might actually be more expensive to go with a new dentist than to see my current dentist, (and pay the extra money that my insurer wants for out of network dentists).
Needless to say, I’m rather disappointed so far with my new dental insurance. I have not yet received any information about the details involved with my health insurance. I really hope that my doctor is considered to be a “Participating Doctor” by my insurer.
Image by Omar Bárcena on Flickr