YOUR DENTAL INSURANCE
(HOW DOES IT WORK?)
Dental insurance is a contract between your employer and a dental insurance company. The benefits you receive are based on the terms of the contract that were negotiated between your employer and the insurance company, not our 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. Many services are not covered, because the benefits have previously been agreed upon by the insurance company and your employer. The contract which your employer and the insurance company agreed upon determines the services for which you will be covered, not your particular needs. Therefore, dental insurance companies rarely cover 100% of any dental fee, and often cover less than 50% or possibly nothing at all!
COVERED/NON-COVERED SERVICES
Unfortunately, some of the services you need or may desire are not covered by your dental insurer. Our goal of providing optimum dental care is not necessarily shared by your insurer. The insurance company's goal is to provide only the negotiated benefits for specifically selected services for the fewest number of people at the lowest possible cost.
The reimbursement mechanism from your dental insurance company is merely a mathematical formula for the benefits you will receive and the percentage of the dentist's fee that will be paid. This percentage is determined by a nebulously preconceived formula based upon a "usual and customary" fee supposedly figured by collecting a given number of dental fees and then applying an average to determine the fees the insurance company will pay. It has been our experience that the fees determined by this method are significantly lower than any average fees in the area. We choose not to compromise your care based upon the arbitrary price restraints imposed by the insurance industry.
Many people do not realize that each dental insurance plan has a fixed dollar amount limitation each year. Once this limit is reached, no other services will be provided by the insurance company, regardless of the need or how essential the service may be for your dental health
HOW OUR OFFICE CAN HELP
Our office will do everything possible to help your understand and receive the benefits to which you are entitled, however the insurance company has the final "say" about what they will or will not pay. We will assist you in filing and submitting the proper forms so that you may receive appropriate coverage. It is in the interest of the insurance company to delay or "request more information" so as to prolong the processing of your payment. If necessary, we may need to ask for your assistance in the timely processing of your claim.
Many insurance companies try to control the amount and type of dental care you receive by "requiring" authorization for certain procedures in advance. In most cases we can begin your care prior to receiving an authorization from the insurance company. In the unlikely event that the insurance company refuses to pay for treatment, you will be responsible for the entire fee. Naturally, we will provide you with the full fees in advance so you may know the cost of treatment.
Like you, we realize that the authorization process is in many cases time consuming and unnecessary.
ELECTIVE TREATMENT
Some services are typically not covered by your insurance company. These may include: cosmetic dentistry, implants, occlusion or bite modification, or other services. Although both yourself and our office may agree that these services are important and would greatly enhance your quality of life, the insurance company will not pay for them if they are not included in their list of services provided. Keep in mind that the dental insurance company is not concerned about coverage for your optimum dental care, but to provide coverage for only a limited number of basic services at the lowest possible cost.
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 desire.
Please let us know if you have any questions. It would be our pleasure to help you!