Understanding Your Dental Insurance & How It Works

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 your employer negotiated with the dental insurance company, which means that many services are NOT covered. Though each plan is different, dental insurance companies rarely cover 100% of any dental fee. In many cases, they cover less than 50% or nothing at all. In addition, each plan has an annual dollar amount limitation. 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 oral health. We suggest you read your plan booklet to familiarize yourself with any services not covered in your plan benefits.

PRE-DETERMINATION POLICIES

Many insurance companies try to control the amount of dentistry you receive by requiring a pre-determination for procedures in advance. Like you, we recognize that this process if often time-consuming and sometimes the treatment cannot wait. Our office will do everything possible to help maximize the insurance benefits to which you are entitled. In most cases, we can begin or schedule treatment prior to receiving a determination from the dental insurance company. However, patients need to understand that in the event the dental insurance company refuses to pay for treatment, they are responsible for all fees. Naturally, we always provide you with the full fees in advance so that you know the cost of treatment.

ELECTIVE TREATMENT

Some services are typically not covered by dental insurance companies. These can include but are not limited to cosmetic dentistry, implants, occlusion or bite redesign and orthodontics. Although these are important dental services that can greatly enhance the quality of life of our 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.

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 is extremely difficult to understand how to make it work or even to work with certain dental insurance companies. That 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 contract the dental insurance company, or we may request your help in this matter.