How Dental Insurance Works

Dental insurance is rapidly playing a larger and larger role in helping people obtain dental treatment. Since we strongly feel our patients deserve the best possible dental care we can provide, and in an effort to maintain this high quality of care, we would like to share some FACTS about dental insurance with you:

1. Many plans tell their subscribers that they will be covered “up to 80% or up to 100%.” In spite of what you are told, we have found most plans cover about 30% to 40% of an average fee. Some plans pay more —- some less. The amount you get is determined by how much your employer paid for the plan. The less he paid for the insurance, the less you will receive.

2. It has been the experience of many dentists that some insurance companies tell their customers that “fees are above the usual and customary fees” rather than saying to them that “our benefits are low”. This is apparently an attempt by the insurance carrier to shift the blame from their poorly funded plans. Remember, you get back only what your employer put in —- less the profit of the insurance company. For example, there could be an estimated insurance fee of $2,375.00 where one insurance company might allow $50.00 and at the same time another insurance carrier might allow $730.00 on an estimated fee of $780.00. Insurance benefits, as you can see, really do not necessarily have anything to do with the fee charged even though that it what the insurance company might imply.

3. Dental insurance is NOT meant to be a PAY-ALL. It’s meant to be an aid in the financial obligation necessitated by dental care.

4. We cannot be responsible for deficiencies or problems in your individual plans. This is between you, your employer and the insurance company.

5. Many routine dental services are NOT covered by all insurance carriers.

6. Your insurance company creates a very personal agreement between you and the carrier. We, at no time, and in no way, are involved with any carrier.

7. As a courtesy to our patients, we will fill out and file ADA approved forms for pre-treatment and final treatment (only after the treatment is complete and financial arrangements are made.) We will do all we can to assure you of maximum benefits.

8. Your particular program may base its dollar allowance on a fee schedule which MAY NOT coincide with current fees in our area.

We hope that this information will help you to better understand the facts behind dental insurance. If you have any additional
questions, we will be more than happy to discuss them with you.