I would like to first and foremost start by professing my support and concern for those who have faced difficulties during this pandemic. My family and I offer our prayers for you.
In this legal issue, I certainly would not consider myself an expert in law. In fact, I try to avoid interactions with the law as much as possible (sarcasm, of course). However, when it comes to legalities and rule-following, in dentistry, the most often experience in comparison is dental insurance.
With regards to dental insurance or any medical insurance, if I could express a point more clearly than anything, it is to avoid using insurance to dictate healthcare treatment. There is a lot to dental insurance to understand, but non-covered treatments and even out-of-network conditions will not necessarily result in denied treatment availability and should not determine the care you need.
For the most part, the majority of dental insurance plans are more or less a discount plan with certain limitations and restrictions. There is often a deductible for treatment in the range of $25-$150 that is paid one time per patient. Treatment then falls under an annual maximum benefit, which ranges from $1000-$2000, or much more, for depending on the plan. Once the maximum is reached, insurance will not help with any further treatment.
From a dental point of view, the most common conflict between dental insurance and treatment is that certain benefits may be denied based on insurance regulations that do not conform to the standard of care. In these cases, there may be a perception that the treatment is not necessary when the opposite is true. It should also be noted that out-of-network plans can be and are often filed by dentists with great success. In-network dental offices are confined to certain regulations that are not bound by being out-of-network. In some cases, insurance coverage is better or more flexible when not constrained to insurance obligations. Of course, this depends on your plan, but it is recommended to discuss these options with your dentist, who can provide more information.
Finally, as mentioned, insurances simply work as a discount, and consequently, many dental offices have created their own discount or loyalty plans that work with great success and with better alternatives than insurance.
At the end of the day, it is best to research the data, get to know your insurance, and find what is optimal for your situation to ensure you are receiving the quality dental care you and your family deserves. Happy smiling!