Dental insurance is very different than medical insurance. It is not really insurance at all, since it rarely covers all or even most of dental costs. In fact very often the most common and beneficial dental treatments are not covered at all. It is really best viewed as a “benefit”. Your dental insurance will provide some benefit to help with your dental costs. Dental Insurance is a highly complex area that creates confusion for many dental patients. The complexities of dental insurance and the lack of sufficient information provided by some insurance companies make it almost impossible for some patients to properly understand their benefits. Even more confusing is understanding how to properly work with your dental insurance company to achieve the highest level of benefits to which you are entitled.
Dental insurance is a contract between your employer and a dental insurance company. The benefits that you will receive are based on the terms of the contract that were negotiated between your employer and the dental insurance company and not your dental office. The goal of most dental insurance policies is to provide only basic care for specific dental services. The services selected are based on the cost of the policy to your employer and the negotiated arrangements with the dental insurance company. Because the benefits you currently have are decided between your employer and the insurance company, many services are not covered. The selection of non-covered services is not based on what you need or want, but is based strictly on the contract with the insurance company. This why so many dental patients become confused about dental insurance. Dental insurance companies never cover 100 percent of any dental fee and, in many cases, cover less than 50 percent or nothing at all. In many ways it is not really insurance at all. It is simply a benefit that you may be able to receive.
Unfortunately, some of the services that you may need or want will not be covered by your dental insurer. Our goal is to help you achieve and maintain optimal dental care, which is not necessarily the goal of your dental insurance company. The goal of the insurance company is to provide only the negotiated benefits for the specifically selected services. The reimbursement amount you receive from your dental insurance company is merely a percentage of what your insurance company arbitrarily decides is customary for a particular area. Insurance companies use the “cheaper substitute rule” to determine which benefits are allowed. If your dentist diagnoses a crown for a tooth and the dental insurance company decides that an amalgam filling will be sufficient for that tooth, the amount paid will be for the least expensive treatment. We do not want to compromise your care based on restraints placed by an insurance company. Another fact that most policy holders do not understand is that each dental insurance plan has a dollar amount limitation each year. Once this limit is reached, no other services will be covered by your dental insurance company regardless how essential the service may be to your dental health.
Our office will do everything possible to help you understand and make the most of your dental insurance benefits. We realize that dental insurance is complex and that it is extremely difficult to understand how to make if work for you. Our office will complete and submit dental insurance forms to the company to achieve the maximum reimbursement to which you are entitles and will work diligently to make this happen as quickly as possible. Please be aware that some dental insurance companies take longer than others to complete payment. If necessary, our office will contact the dental insurance company, or we may request your help in this matter.
Many insurance companies try to control the amount of dentistry you receive by requiring authorization for procedures in advance. Our office will do everything possible to help you maximize the insurance benefits to which you are entitled. We can begin treatment prior to receiving an authorization from the dental insurance company. The authorization process is often time consuming and unnecessary and often gives the insurance company an opportunity to deny treatment. We always provide you with the full fees in advance so that you know the exact cost of treatment.
Some services are typically not covered by dental insurance companies. These might include: cosmetic dentistry, teeth whitening, dental implants, occlusion or bite redesign, and other services. Although these are important dental services that can greatly enhance the quality of life of our patients, dental insurance companies do not feel that they should have to pay for these services. That is why these services are rarely included in contracts with your employer. Ask Us For Help Any Time. Any time you have a question about your dental insurance, please feel free to ask us. We recognize that dental insurance is becoming more complex and more difficult to understand everyday. This is often due to the quest by dental insurance companies to reduce costs through continual change. Keep in mind that the dental insurance companies are not concerned about coverage for optimal dental care, but provide coverage for only a limited number of basic services.
We are dedicated to providing optimal care for every patient and working with you to achieve that goal. We want to provide the quality of care that you deserve. Please contact us if you have any questions — it will be our pleasure to serve you.
