Understand your health and dental insurance coverage

Not doing so can cost you.  Allow me to explain how it cost me.

I have had a fair amount of dental work, and opted for supplemental dental insurance through my employer.  It's not cheap insurance, but it does allow for coverage on “the expensive stuff” like crowns, multi-face fillings, root canals, etc.  My health insurance has coverage only for the most basic maintenance like no-frills checkups and some fillings, and doesn't even touch the big expenses.

My teeth need a lot of work done on them because at one point I didn't take very good care of them.  Some of my fillings had been replaced several times, and porcelain caps were needed for those.  These are a grand, and I had two done since the beginning of the year.

I had been going to a dentist close to where I live, and I knew she wasn't a member of any dental HMO plans, and none were offered through my work until a couple of years ago.  She provided good service, so I continued going to her, knowing that it would be expensive because I really couldn't get coverage anyway.

When my workplace started offering supplemental dental insurance, I was surprised to find out that she took the insurance that my work offered.

This was my mistake:  I didn't ask any more questions beyond that.  I assumed that because she took the insurance that I'd be covered under what I thought would be pretty decent reimbursement for expensive services.  The dentist's office didn't lie to me; they did take the insurance.  They just weren't in the preferred network.  It was only in the preferred network that I got the reimbursement for the expensive services.  So, I got almost nothing for this expensive work.  Oops!

I thought I had done due diligence; I asked the dentist before I signed up for the supplemental insurance.  But the goals of the dentist and her staff are clear:  get me in the door, work on my teeth, and charge fees.  Whether I get reimbursed for half of the work, or for none of it, doesn't matter.  I can't fault them for that.  That's exactly what they should be doing.  They didn't force me to get my teeth worked on there, and they'd be stupid to ask me too many questions about my coverage, because I just might go somewhere else.

On the insurance end of it, the insurance company doesn't care where I get my teeth worked on, or if I get them worked on at all.  They take my premiums, and process claims according to the policy agreement I have with them.  They're more than happy not to pay me back much money.  They're not lying to me either: they have a full directory of their network online, and sure enough, my dentist wasn't on it.  (If she were, I'd still need to verify that, because the dentist might have dropped out since the last update of the directory.)

Which gets to the title of the post:  You have to understand your health and dental insurance coverage yourself. The doctors and dentists are concerned with staying in business and providing quality service.  The insurance companies are concerned about staying in business.  These concerns are separate from the patients' concerns about how much they pay.  Neither one ultimately cares that much about how much you pay, as long as they're doing what they agreed to do.

Here's what I learned through this little gaff: “We take that insurance” doesn't mean “We are in the preferred provider network.” Unless you read the policy, and know what questions to ask of the dentist/doctor, you might assume that you're getting reimbursed for certain services when you're actually not.  (Also, be sure to verify with the dentist or doctor even if you see that they're in the preferred network on the insurance website.)

I hope that hearing about my mistake saves you some money and disappointment.