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Office Visit Co-payments, Dental Co-insurance and Plan Deductibles

What is an office visit co-payment and co-insurance?

An office visit co-payment is a fixed dollar amount or a percentage that you pay for each Family Dental Insurancedentist visit or for each dental service provided. For example, with some plans you may pay a fixed amount such as $5 or $10 per visit. Other plans will charge you a percentage of the total fee - or dental co-insurance -- for the visit. So if your co-payment is 10% and the dentist visit was $200, you would pay 10% which, in this case, would be $20.

What is a dental insurance deductible?

A deductible is the amount of annual dental expenses that a dental plan member must pay before the dental insurance plan will begin to cover expenses. For example, if your plan has a $50 deductible, you will pay the first $50 of your dental expenses before your dental plan begins paying the expenses. Only expenses for covered services apply towards the deductible. For example, if you paid $1,000 for orthodontic work that was not an expense covered by the plan, then the $1,000 will not apply toward your annual deductible.

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Dental Fees

Fortunately, in these times, a lot of patients have dental insurance. Insurance is, on the face of it, a good thing. It minimizes out-of-pocket expenses for treatment and encourages people to keep up with the dental care they need. But most dental insurance plans do not pay 100%. There simply is no perfect insurance plan.

Part of the problem is what's called "usual and customary fees." Insurers have come up with a fee structure intended to reflect the "average" cost of "average" dental care. Urban residents may be allowed different compensation than people who live in rural areas. Reimbursement for a crown may be a certain percentage of the actual cost (the dentist's charge to you), and another percentage for a cleaning. Patients are sometimes puzzled at the discrepancy between insurer reimbursement and actual dental fees.

Of course your dentist can't dictate the amount your dental insurance plan decides is "average." And they don't ask your dentist what cost he or she thinks is fair. The dilemma is this: your dentist can't, in good conscience, recommend less than quality dentistry, even though your insurer may impose an unreasonable ceiling on treatment. It's a rock and a hard place.

For this reason, you should take objections directly to the insurer or compare dental plans with your employer. If enough people make enough noise, the reimbursement picture might improve.

Ask your dentist to sit down with you and go over your dental plan and your dental financing options. He or she will try to make your dental insurance plan work to your advantage. Your dentist cares about your finances, and your health.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.