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 has been around for over 30 years. The typical maximum benefit then was around $1000 for a calendar year. Some 30 years later, the maximum yearly limit is still $1000, yet premiums have risen substantially. As a result, insurance companies limit what they cover, and prolong the reimbursement process with unnecessary, and repetitive paperwork. Ultimately, it is the patient that suffers. Remember, insurance companies are a business and only care about their bottom line.
What Is Dental Insurance?:
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 the 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.
The benefits that you receive from the dental insurance company for your current insurance plan have nothing at all to do with you achieving a high quality complete result.
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 is why so many dental patients become confused about dental insurance. Dental insurance companies rarely cover 100 percent of any dental fee and, in most cases, cover less than 50 percent or nothing at all.
Covered & Non-covered Services:
Unfortunately, some of the services that you may need or want will not be covered by your dental insurer. Out 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 mechanism from your dental insurance company is merely a mathematical formula as to which benefits you will receive and the percentage of the dentist’s office fee that will be paid. We do not want to compromise your care based on restraints placed by an insurance company.
Another fact that most dental patients do not realize 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 of how essential the service may be to your dental health.
How Our Office Helps:
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 it work or even to work with certain dental insurance companies. This is why we provide full assistance to you.
Our office will complete and submit dental insurance forms to the company to achieve the maximum reimbursement to which you are entitled 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.
In most cases, we can begin treatment prior to receiving an authorization from the dental insurance company. However, patients need to understand that in the event the dental insurance company refuses to pay for the treatment, you are responsible for all fees. Naturally, we always provide you with the full fees in advance so that you know the exact cost of treatment.
Like you, we recognize that the authorization process is often time consuming and unnecessary.
PPO’s – Preferred Providers:
PPO does not mean you are “required” to go to a participating provider. If you go out of “network” you are still entitled to your benefits. Although I do not participate in many PPO’s, you can still come to me and maintain your benefits. Payment is expected at the time of service, and we will file all claims for you.
Some services are typically not covered by dental insurance companies. These include cosmetic dentistry, implants, occlusion or bite redesign, and other services. Although these are important dental services that can greatly enhance the quality of life of 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 changes. Keep in mind that the dental insurance companies are not concerned about coverage for optimal dental care, but provide coverage only for a limited number of basic services.
Our office remains dedicated to providing optimal care for every patient and working with you to achieve that goal. We pride ourselves on helping you in any way and in continuing to provide the quality of care to which you have become accustomed.
Please let us know if you have any questions, it will be our pleasure to help you.