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Insurance

Important Facts Regarding Dental Insurance

 

    Our office has always been happy to work with patients covered by dental insurance. Your knowledge of your dental insurance coverage can assist our staff to help maximize your benefits. For specific information on your dental insurance coverage, please contact your insurance carrier and review your policy.  We strongly feel that our patients deserve the best possible dental care that we can provide. In an effort to maintain this high quality of care, we would like to share with you some facts about dental insurance.

Fact #1

    Dental insurance is meant to be an aid to help restore your mouth to sound dental health. It has been the experience of many dentists that patients have gotten the impression their plan will pay up to 80%, even 100% of their dental fees. In spite of what you are told, we've found many plans cover about 40-50% of an average fee. For the same procedure, some plans pay more - some less. The amount your plan pays is determined by how much your employer paid for the plan. The less paid for insurance, the less you will receive in benefits. The more paid, the better you will receive.

Fact #2

    It has been the experience of many dentists that sometimes companies tell their clients that certain dental fees are "above the usual and customary" rather than tell them that the insurance benefits are too low. We know that some companies do not upgrade fee schedules regularly, even with the cost of living index. Remember, since the insurance company must make a profit, you can only get back in benefits what your employer puts in, less the profit the insurance company wants to make.

Fact #3

    Please read your policy so you are fully aware of any limitations of the benefits provided. Many routine dental services are NOT covered by insurance carriers. In fact, some preventative procedures are not covered at all.

Fact #4

    Insurance is submitted after each visit. The patient, however, is responsible for the total fee and will be expected to make up for any deficiencies in the insurance coverage.

Fact #5

Managed Care Plans

    It is important that you understand the method by which the dentist receives payment for your care from the managed care plan. In an HMO, PPO, or capitation plan of insurance, the dentist receives a monthly capitation (per head) fee for each patient signed up on his list. These monthly fees are low and the dentist is usually further ahead by NOT SEEING THE PATIENT!

    Our office has reviewed managed care plans, and we chose not to participate in these plans. For us to become a "preferred" provider, we would have to compromise the quality of care we are currently committed to delivering to our patients. We would not be able to employ the quality staff that we now have. The exceptional infection control assurance we have would likely be compromised, and the excellent dental laboratories we use would have to be dropped and lesser quality laboratories employed.

Some managed care programs allow the participants to continue to receive optimum care from their current dentist, even if they are not a PPO/HMO provider. This may be an option for a small additional fee or no fee at all.

Summary

  • The fees for services rendered are the same charged to all patients for similar services, regardless of whether the patient is covered by insurance or not.
  • Your insurance policy may base its payments on a schedule which may or may not coincide with current acceptable fees in our area.
  • Insurance companies vary greatly in the types of coverage available; even within the same company.
  • All patients are financially responsible for their accounts. The insurance company is responsible to the patient. We strongly suggest that you become familiar with your dental coverage. We will cooperate in any way we can to help you obtain maximum benefits.
  • Benefits have nothing to do with fees charged.
  • Insurance coverage is a matter between your employer and the insurance company. We are not involved with any insurance company, and therefore your benefits are not determined by this office.
  • Our staff is happy to help with any insurance questions that you may have. However, it is your responsibility to review and understand your insurance coverage.