Important Facts Regarding Dental Insurance

We strongly feel that our patients deserve the best possible dental care we can provide. In an effort to maintain this high quality of care, we would like to share with you some facts about DENTAL INSURANCE. We file insurance as a courtesy to our patients and this is done though electronic processing.

PLEASE UNDERSTAND THAT NO PLAN IS A PAY-ALL
Dental insurance is meant to be an aid to help functionally restore the mouth to sound dental health. It must be considered only as a subsidy for reconstructive dentistry.

It has been the experience of many dentists, however, that patients have gotten the impression that their plan will pay up to 90%, even 100% of the dental fees. This is simply not true. Most plans cover from 30-40% of the average total fee. Some pay more, some less. The percentage you receive is determined by how much your employer has paid for coverage. The less paid for insurance, the less you will receive in benefits. This is a basic economic fact.

THE BENEFITS ARE NOT DETERMINED BY OUR OFFICE
Insurance benefits are determined by the type of plan chosen by your employer. We are not involved with the insurance carrier in any way. Since dental services are rendered directly to the patient, it is ultimately the patient who is responsible to us for the payment. The insurance company is responsible to the patient. To avoid disappointment, we strongly suggest that you contact your insurance company to make sure that your assumptions are correct.

CONSIDER THE DEDUCTIBLE AND CO-INSURANCE FACTOR
To illustrate, consider this example: A doctor places 4 units of dentistry at $150 per unit, amounting to $600 in value. Assume that the "usual and customary" allowance is $100 per unit. You'd estimate that insurance coverage should pay 4 times $100 or $400.

But it won't. First, a deductible is subtracted - say $50. So, you'd estimate that insurance should pay $400 minus the $50 deductible which equals $350.

But again, it won't, because the co-insurance factor (say 80/20) must be calculated. In other words, the insurance company will pay 80% for $350, or $280. The patient is then responsible for the remainder -- $320.

EVERY CASE IS DIFFERENT
For example, one dentist recently noted a case in which the estimated fee was $2375, and the insurance company allowed $50.25. On the same day on an estimated fee of $480 for a different case, the insurance company allowed $382.50. In the first case, the allowance amounted to 2% and in the second, the coverage amounted to almost 80%, although such a percentage is rare.

SOME ROUTINE DENTAL SERVICES ARE NOT COVERED
Please read your policy so you are fully aware of any limitations on the benefits provided. We cannot be responsible for deficiencies or misunderstandings with individual plans. These matters are strictly between your employer and the insurance company.

A MAXIMUM COVERAGE PER YEAR MUST BE CONSIDERED
A maximum refers to the total liability of an insurance company. This maximum is usually based on a yearly basis. The year may be January to December. Some companies use fiscal years such as August to July. Please check this with your individual plan.

WE DO ALL WE CAN TO DERIVE MAXIMUM BENEFITS
We are happy to complete forms and send them to your insurance company. We utilize electronic filing to be reimbursed as quickly as possible. The patient, however, is responsible for the total fee and will be expected to make u for any deficiencies in the insurance coverage.