Understanding your Yearly Dental Benefits

Most of us are watching our spending habits with more scrutiny these days since 2008.  We shop for better gas prices, we look for coupons on the internet, we wait for Black Friday to buy that big screen TV.  So why don’t we pay closer attention to understanding our yearly dental benefits?

Many of our patients have great dental benefits afforded to them from their employer.  Understanding the terms and conditions of the policies is the employee’s task.  Patients must understand terms such as “Yearly Maximum” and “Remaining Benefits”.

Yearly maximum refers to the maximum amount that your dental insurance will pay in a calendar or fiscal year.  Your insurance company will not pay $1.00 more that your maximum for any reason.  Most patients have around $1500-$2000  as their yearly maximum.  If your maximum is less than $1500, you may want to talk to your HR department and inform them that that amount of $1000 is the same amount that was set in the early 80’s.  The cost of dentistry has gone up 400% since then,  yet the yearly maximum has remained the same.  That just does not seem fair.  As I tell patients with a $1000 maximum, “that covers just one tooth ache a year”.  Talk to your HR/ employer and have them do a better job negotiating your yearly dental benefit contracts.

Remaining benefits refers to how much of that yearly maximum the patient has remaining.  This is a very important number to know as we approach the end of the year.  Dental insurance is a “use it or lose it” policy.  So, for example, if a patient had $500 remaining and did not utilize the remaining benefits, it does not roll over into 2017.  Many patients have had dental procedures proposed by their dentist, and for one reason or another, have postponed them.  By delaying dental treatment to the following year, you put yourself at a financial and health risk.  Obviously from an oral health perspective, neglecting dental decay and infections and gum disease can lead to problems in one’s overall health and specifically, cardiac issues.  From a financial perspective, by not maximizing your remaining benefits, so can severely compromise how much your insurance will cover in the following year.  If that “tooth ache” arises, you can use all your benefits in January and have the remaining 11 months with no insurance.

At Torrey Hills Dental our patients can have a complimentary insurance analysis done by our staff by simply calling our office and asking them to review your remaining benefits and proposed treatment so that you can make the best decision for your health and your wallet.
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Born and raised in San Diego, Dr. James Tasto attended University of San Diego High School where he lettered in both golf and wrestling. After earning a Bachelors in Science from Loyola Marymount University, Dr. Tasto graduated from University of Southern California Dental School with an emphasis on cosmetics and sports dentistry.  Dr. James Tasto was selected by his peers to be included in the List of Top Dentists in San Diego for 2007 – 2013.  He appeared in the May issue of San Diego Magazine.  Dr. Tasto is also a member of D.O.C.S. (Doctors Offering Charitable Services), a local organization that offers medical services such as plastic surgery, vision and dental to the less fortunate patients in San Diego.  Dr. Tasto currently resides in San Diego with his lovely wife Traci and their 3 children. He enjoys golf, beach volleyball and playing with his kids.