For our patients fortunate enough to have dental benefits
If your employer offers dental insurance, consider yourself fortunate. Dental insurance is not really “insurance” at all. This benefit works like a valuable "coupon" that can reduce the costs of dental care. However, no dental benefit plan is set up to cover all of your costs. Your dental benefits help offset the investment of getting quality dental care performed for you and your family and it is our pleasure to assist you in maximizing your insurance benefits. As a courtesy to our patients, we will complete your claim forms and submit those claims. To avoid surprises on your dental bill, it is important to understand what your benefits will cover, and what you will need to cover some other way. At our practice we would prefer misunderstandings not occur and we want you to understand your dental benefits.
The role of your dental office
Your dentist's main goal is to help you take good care of your teeth. We do not base our treatment recommendations on what the insurance company will cover but rather what the best treatment is for you. We will assist you in any way that we can (including electronic claims submission and submitting pre-determinations). Our office will complete and submit dental insurance forms to the insurance company to achieve the maximum reimbursement to which you are entitled and will work diligently to make this happen as quickly as possible.
How dental plans work
Almost all dental plans are the result of a contract between you or your employer and the insurance company. The amount your plan pays is agreed upon by your employer with the insurer. Your dental coverage is not based on what you need or what your dentist recommends. 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 you or your employer and the negotiated arrangements with the dental insurance company. If you are not satisfied with the coverage provided by your insurance, let your employer know. Please realize that dental benefits are not communicated to employers, consumers or healthcare professionals in a universal format. Your dentist is not a party to that contract and therefore it is impossible to guarantee insurance benefits to any patient.
Unfortunately, some of the services that you may need or want will not be covered by your dental insurer. Although these are important dental services that will improve your oral health and greatly enhance the quality of life, 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. Most dentists’ 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. 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 will discuss all treatment options available, the pros/cons to each option, as well as the costs associated with each treatment. As always, whichever treatment option works best for you is what we will support! We do not let insurance companies dictate your treatment. We provide what treatment is best for you and not what is best for the insurance company!
Another fact that most dental patients do not realize is that each dental insurance plan has a dollar amount limitation each year. This is the largest dollar amount a dental plan will pay during the 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. Your employer makes the final decision on maximum levels of payment through the contract with the insurance company. Due to this contract, you are expected to pay copayments, as well as any costs above the annual maximum. If the annual maximum of your plan is too low to meet your needs, ask your employer to look into plans with higher annual maximums.
Dental benefits can be very confusing and we are here to help you in any way that we can! If you ever need anything, please ask!