In 1965, 2 million people were covered by dental insurance. Presently, over 33 million people have insurance plans. Since dental insurance is a major fringe benefit in many major companies, it is rapidly playing an increasing larger role in helping people to obtain much needed dental treatment.
We strongly feel that our patients deserve the best possible dental care we can provide. In an effort to maintain this high quality care, we would like to share with you some facts about dental insurance and how it works.
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% to 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 simple terms, did they purchase an economy car, or a luxury car?).
FACT #2 It has been the experience of many dentists that sometimes insurance companies tell their clients that certain dental fees are “above the usual and customary” or UCR, rather than tell them that the insurance benefits are too low. We know that some insurance companies do not upgrade fee schedules, even with the cost of living index. Dental insurance in the 1960’s paid out an average of $1,000 of dental benefits per year. Today, more than 40 years later, the average is still $1,000.
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 (i.e. the less they pay, the more they profit).
FACT #3 Please read your policy so that you are fully aware of any limitation of the benefits provided. Many routine and recommended dental services are not covered by insurance carriers. In fact, some preventive procedures are not covered at all. There are a number of clauses insurance companies use to deny payment, such as pre-existing conditions and alternate (cheaper) benefits.
FACT #4 We are happy to cooperate with any patient whose treatment is covered by dental insurance and will be happy to fill out the forms and submit the claims as a service to you.
FACT #5 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.
We are here to help you sort through the confusing issues related to your dental insurance and would be happy to discuss our fees and policies with you at any time. Our computer can give an estimate of what your insurance plan should cover, but remember this is only an estimate.
– 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 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 (we deal with well over 500 different plans on our computer).
– 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 the maximum benefit that you have paid for.
– BENEFITS HAVE NOTHING TO DO WITH THE 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 our office.
– If you or your employer is looking for new dental insurance coverage, ask us about DIRECT REIMBURSEMENT plans that eliminate the “middle man” and cut employers costs without sacrificing quality.