Dental implants are becoming a common solution to missing teeth and an alternative to bridge and crown work. However, according to WebMD.com, many dental insurance plans do not cover implants. My husband, Dave, learned this the hard way when our dentist convinced him to replace a worn-out bridge with 2 dental implants. Dave has employer-provided dental coverage through a nationally known insurance carrier so our dentist submitted a pre-certification form before he began the work on the dental implants. The insurance carrier denied the coverage but DID provide the lower negotiated rate for the procedure on the rejection letter. Our dentist wanted to charge $3,600 but the discounted PPO rate was actually only $2,800.Unlike all those magazine ads for “teeth in a day,” it took several months from start to finish for Dave to get his new pearly whites. When the procedure was finally complete, we got the bill in the mail. Now, since the pre-certified PPO price was $2,800 according to our dental insurer, that’s what I assumed the bill would be for. But you know what they say about assuming things. When I opened the mail, the bill was for $3,600. I immediately called Dr. Tom, our dentist, to see why we were not getting the discount. “Well, since your insurance isn’t covering the procedure, you don’t get the negotiated discount,” I was told by Dr. Tom. Now, how many of your employees might have stopped there and wrote a check for the full $3,600? I’m betting quite a few wouldn’t even question this logic.
However, I went online to see if Dr. Tom was correct. Contrary to his wanting to charge us the full price, the insurer’s website states that he had signed on to be “part of the national network of participating dentists who have agreed to accept a fee schedule of maximum allowable charges as payment in full when treating PPO members. The fee listed in the schedule is the total amount the dentist will receive, which includes both payments from the insurer and/or applicable member payments.” It took me three weeks of arguing with Dr. Tom’s receptionist but finally Dave’s bill was reduced to the PPO price of $2,800. That was a difference of $800, well worth fighting for!
So how can you keep money in the hands of your employees and help avoid these hidden charges? It all starts with education. Plan sponsors have made significant improvement these last few years with enhancing retirement plan education but other than during open enrollment, there usually isn’t much education that revolves around health and dental insurance. If your employer offers a PPO option, make sure to spread the word that the PPO negotiated rates are a perk even if the plan doesn’t actually cover a particular procedure. These discounts can significantly reduce the out-of-pocket costs your employees may face on treatments that are commonly not covered by insurance such as dental implants and LASIK eye surgery. Make it a point to post an article in your monthly newsletter about the PPO discounts or host a workshop on your voluntary benefits, including a refresher course on the health, dental, vision, and life insurance plans that are available to your workforce. This way, the tooth fairy can give money to your employees, not take it away from them.