AMC GremlinImagine this scenario. After a snowfall in the cold of January, you slip and fall, breaking your arm and chipping your tooth (ouch!). Both the tooth and the arm need to be placed in a cast and the tooth will need a crown. They are both covered by the dental policy and the medical insurance.

Fast forward to next year while you’re shoveling snow in March. You fall again and break the same arm and tooth. Medical insurance covers your broken arm but guess what? The dental “insurance” states that since the tooth was fixed recently, you must wait five years before it can be fixed again!

It is imperative to understand your benefits because the contract has nothing to do with the care you receive. Rather, it is based on the plan your employer purchased.

It’s not because your dentist charges too much

Your insurance may not cover 100% of the fees but it is not, as you might think, because your dentist charges too much. Instead, it is because the benefits in the contract may state a percentage of fees that could be based on average fees from 3 – 5 years ago (and the “insurance” companies don’t even have to tell where they came up with the fees).

Even though you may have two benefit plans, there is no guarantee that either plan will pay for the services provided.

A new car for $4,000?

When benefits were first introduced in the early 70s, the maximums for coverage was $1,000. The max on average in 2012 is now $1,500 (a 50% increase). I don’t know about you but my hot new automobile (a Gremlin) I purchased back in 1972 was about $2,300. Wouldn’t it be nice if you could buy a new car today for only 50% more (about $4,000)?