Understanding Dental Insurance

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We would like for all of our patients to better understand their dental insurance.

We are not in network with any dental insurance companies but, are happy to file your insurance for you and accept assignment of benefits.  BCBS and most Delta Dental plans will send payment to the patient so you will be required to pay at the time of service.

 

The first thing to know is that dental insurance is not insurance at all. Insurance originated as, and is by definition, a pooling of funds to pay for a rare, but catastrophic event. Fire insurance is an excellent example. Originally, medical insurance was also designed this way. Payment for routine office visits, basic medications, and low deductibles are a relatively recent modification in medical policies to create additional employee benefits that are not true insurance but "tax-free" benefits.

At our office, we believe that you deserve the best in dental care. That is why we always present you with the best dental solution possible to treat your personal situation.

We do not decide on your dental treatment based on what your insurance may pay.  We base your dental treatment on the dental need to make you healthy.  Each year we provide outstanding dental care to thousands of people. Some have dental benefits, but most do not. If you have dental benefits, congratulations! You are very fortunate.

Here are some important things you should know:

  • Your dental benefits are based upon a contract made between you or your employer and insurance company. If you have any questions regarding your dental benefits please contact your employer or the insurance company directly.

  • Dental benefits differ greatly from medical benefits. In 1959, most dental benefit plans had a yearly maximum cap of $1,000 & you will be surprised to know that the average dental benefit plan today still has a yearly maximum cap of $1,000. There has been no significant increase in the yearly maximum cap in over 40 years! However, there have been significant increases in your premiums. Dental benefit plans will never pay for completion of your dental care. It is only meant to assist you.

  • Many people receive notification from their insurance company that dental fees are "above usual and customary". An insurance company determines their reimbursement level by surveying a geographical area, calculating the average fee, then determines that 80% of the average fee is customary. Included in the survey are discount dental clinics and managed care facilities, which have severely reduced dental fees that bring down the average. Any doctor in private practice will have fees that insurance companies define as "higher than usual and customary".

  • Insurance companies do not recognize many routine and newer dental services. Our team will gladly assist you in filling out the necessary forms to maximize your dental benefits and discuss your financial options. Excellent dental care is available with or without dental benefits. We hope you choose the best dentistry has to offer.

  • Many plans confuse participants by giving the In-network as opposed to Out-of-network benefits. After reviewing many plans, the benefits only slightly vary between in-network and out-of-network. Before deciding on going to an in-network provider of your insurance, you need to evaluate the level of treatment and patient care you will be receiving.  We are happy to file and accept assignment of benefits to any insurance.  

What is assignment of benefits? As a service to patients, a dental office may accept assignment of benefits whereby they agree to have the patient request that his or her dental plan provider pay the dental office directly for the percentage of the cost covered. The patient is responsible for paying the co-payment when treatment is provided and any balance not covered by the insurance company.  In some cases, a dental plan company will only reimburse the plan holder requiring the patient to pay for all costs at the time treatment is provided (Delta and BCBS are examples). In all circumstances, the patient is responsible for any costs not covered by his or her dental plan.