FSA/HSA

Flexible spending accounts (FSA) and health savings accounts (HSA) are accounts that let you set aside money, tax free, for medical and dental expenses. An FSA is part of an employer’s benefits package. If you don’t use your FSA dollars by the end of the year, you lose them, unless your employer has a rollover option. With an HSA, the money does not expire.

If you don’t know whether or not you have an FSA or HSA, be sure to ask your employer or insurance company.

FSA and HSA dollars can be used for any medically necessary pediatric dental treatment. This often includes exams, cleanings, fluoride treatments, dental sealants, fillings, orthodontic appliances and more. Cosmetic treatments like teeth whitening, which aren’t common for kids anyway, aren’t usually covered.

If your benefits expire at the end of the year, you’ll have until December 31 to use your FSA dollars. However, it’s always recommended that you check with your employer for the details of your specific plan.

Yes, you can use your insurance and your FSA or HSA money.

These facts about insurance are provided to answer a few of the more common patient questions.

• Dental insurance is a contract between you, your employer and your dental insurance company. The employer usually buys a plan based on the amount of the benefit and how much the premium costs per month. Most benefit plans are only designed to cover a portion of the total cost. Typically, the lower the premium cost the lower the benefit level.
• Many carriers have “allowed” amount. They refer to these allowed amounts as UCR, which stands for usual, customary and reasonable. However, UCR does not always mean what it seems to mean…..it is actually a listing of payments for all covered procedures negotiated by your employer and the insurance company. This is directly related to the cost of the premiums. The benefit profile may show 100% coverage for a procedure but it may have a maximum plan benefit for that same procedure. For example, your dental office may charge $80 for an examination, but your plan has a maximum UCR of $60 for that particular procedure. Even though it states 100% coverage, it will only pay the maximum for that plan resulting in a $20 balance that then becomes the patients’ responsibility.
• Insurance plans have an annual maximum limit on the benefits offered. Maximum limits are what a carrier has to cover each year. Amazingly, despite the fact that costs have steadily increased, annual maximum levels for dental care have not changed since the 1960’s.
• Many insurance plans require you to select a dentist from a list. Usually the dentist on the list has agreed to a contract with the benefit plan. If you choose a dentist on the list, you typically will pay less toward your dental care than if you choose a dentist not on the list. Some of these plans have “out of network benefits” which means you can see a dentist not on the list. Your financial responsibility may or may not be affected by seeing a dentist not on the list which is why it is extremely important that you make yourself familiar with your particular plan. If your dentist is not on the list this does not mean that something is wrong with the dentist or the practice. Some plans require that the network dentist observe restrictions to treatment, or treatment alternatives such as a filling instead of a crown. Many dentists are not comfortable with these restrictions as they relate to patient care and believe treatment recommendations should be the sole responsibility of the treating dentist and therefore do not join some of the more restrictive networks.

With over 23,000 insurance plans covering over 110 million Americans today, it is important that you read your policy and coverage profile booklet carefully to maximize your individual benefits.

Ultimately, you are responsible for the entire cost of dental professional services regardless of your insurance benefit so know your plan benefits prior to your appointments.