Policies that allow dental benefits companies to set fees for services for which they do not pay providers are also known as “non-covered services policies.” These policies set a cap on the amount that a participating dentist can bill a patient for services not covered under the plan, thus setting a maximum allowable fee on non-covered services.
Allowing non-covered services policies forces dental providers to shift costs to other patients and increase fees for private-pay patients who pay out-of-pocket for care in order to continue operating high-quality dental practices. Private payers are often elderly people or young adults with limited employment and sources of income, or low-income workers whose employers do not provide dental benefits.
Private-pay patients suffer the greatest financial burdens of non-covered services policies. These individuals are forced to subsidize the care of other patients with dental plans to protect the bottom line of the dental benefits companies.