3 Insurance Struggles in the New Year

We have a love-hate relationship with Insurance companies. On one hand they help pay for expensive health and dental procedures – ones we need to be healthy and comfortable! But on the other hand, their entire existence revolves around not paying for anything they can get away with. Their survival depends on constantly exploiting any loophole, any typo, any red-tape which allows them to ferret their way out of paying, leaving you with the bill!

If all else fails, insurance companies will make receiving your necessary and rightful benefits such a nightmare that you just give up and pay for it yourself.

That is how they win.

Do not let them win.

The turn of a new year in particular can present several brand-new challenges to navigating the complex world of insurance. Just when you thought you had your coverage figured out, the ball drops in time square and you’re back to square one, and suddenly faced with maximums and deductibles and other gibberish you didn’t expect.

We understand; we see it every day.

That is why I’ve compiled this list of three insurance struggles you might find yourself faced with this time of year! To help you tackle the beast that is dental insurance without any unpleasant surprises.

1

Did your employer change your insurance?

In our office we verify insurance before we see each child. Occasionally, especially in the first few months of the year, we come across a terminated insurance plan that parents weren’t expecting to end. Often their company will have switched insurance providers without telling anyone. We have two options when this happens. Either the parents make a series of calls to HR departments and insurance companies to track down their new coverage information, or we have to postpone the appointment until their new cards arrive. Either way, the situation is a hassle for you and your children.

By checking your dental coverage before setting or attending appointments, you could avoid this annoyance altogether.

But not every company will just change insurance providers without informing their employees. If you know your job has decided to go with a different plan this year, make sure you share the love. Letting your dentist in on changes to your coverage before your appointment will allow them to verify your insurance ahead of time, eliminating unnecessary waiting room time.

Additionally, having the correct insurance card with you for your appointment speeds this process along, but if you haven’t received your new cards yet, make sure you know your new member identification number and/or group number.

Staying ahead of the game will help us verify your coverage, meaning you won’t get stuck with the whole bill and your appointment will go much more smoothly.

2

Does your plan have a deductible?

A deductible is an amount of money you must pay before your benefits kick in. Many dental plans have an annual deductible of around $50 per person. This means that before your child can have any dental work done, you will be charged $50 in addition to your regular costs for that work.

These little devils reset every year, which means you might end up owing money for services you thought would be fully covered. Most dental plans won’t charge the deductible for preventative care, such as your child’s six-month cleaning and exam, but occasionally insurances will charge that deductible even during these routine checks. That’s one more reason to make sure you know your coverage very well, and to make note of your annual deductible.

3

Did you reach or exceed your maximum?

Maybe you brought your children in before the end of the year. You avoided all of the New Year’s insurance struggles then, right? But maybe in the following months you received a statement in the mail saying you owe money for last year’s dental work, and you don’t know why. It might be because you reached your annual maximum last year.

An annual maximum limits the amount that your insurance will pay for dental care each year. Sometimes parents get bills in January or February for work which happened in December, after they met or exceeded their annual maximum.

One way to avoid this is to request information from your insurance on the history of use in your dental plan. They’ll let you know how much your maximums and deductibles are for each family member, and they’ll tell you how much they’ve each used so far this year. Keeping up on your annual maximum can help you avoid any surprise bills in the mail. If your insurance company tells you that you’ve almost met your max in December, you may be able to schedule appointments in January, when your maximum resets, and avoid any additional out of pocket expense.

In the end the most important thing you can do when fighting the war of insurance, is know your coverage very well. If you familiarize your self with their tools, you can prepare yourself for, and sometimes avoid dealing with their nonsense altogether.

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