A Word about Dental Insurance
We participate in many dental insurance plans and are eager to help you with your claims. In this regard, we offer the following tips:
- When you come to an appointment, please bring a claim form with your portion completed and signed, where appropriate.
- Take advantage of the pre-treatment estimate feature for more extensive dental care. This allows you to discover the costs your insurance carrier will cover prior to the start of extensive treatment.
- Remember that except for preventive and diagnostic services, most plans pay only a portion of your fee. You are responsible for any amount not covered by your plan.
- We will be happy to assist you in handling your insurance claims. We request that you settle your account with us and have your insurance carrier reimburse you for the services provided.
- Please do not request that we alter dates of treatment or falsify insurance claims. This is illegal and can be disastrous for all concerned.
FACTS ABOUT DENTAL INSURANCE
How Most Medical Insurance Plans Work
A typical insurance plan is designed to protect a person against loss. For example, auto and home insurance is designed to replace your car or home in the event of catastrophic loss. These insurance plans generally include a deductible intended to limit the company's involvement to large claims. Medical insurance has traditionally worked in a similar fashion. In all of these plans, the maximum limit on payment is large enough to cover even the most severe loss.
How Most Dental Plans Work
Dental insurance works differently. Dental insurance almost always has a relatively low maximum payment; some also have a deductible. The maximum limits are usually $1000 or $2000 per year and deductibles can be as high as $500. All expenses below the deductible and above the maximum limit are to be paid by the patient. In the event of an abscessed molar tooth (a very common event in dentistry), such insurance coverage will often not cover the cost of the required root canal, post, and crown treatment. Many companies limit the amount they pay on given procedure. Often these allowances are less than the cost of the services you need. In addition, most state-of-the-art procedures are not covered at all. Many of these programs are useful only for maintenance care (where allowances are more appropriate) but provide relatively little assistance when restorative work is required.
What Happens When You Need Reconstruction?
In the event that you have worn out your dentition and need major reconstruction, dental insurance plans are of limited benefit. Even if you have been insured for 20 years and have not filed a claim during this time, you are still allowed only annual the maximum coverage. On rare occasions reconstruction work can be done at a rate of one tooth per year. In most cases, treatment under these limitations simply is not possible. An analogy might be an offer to pay you $5000 a year to rebuild a lost home. Even if it were possible to work this way, work would be severely compromised and many homeowners would not live long enough to see the completed result.
Insurance & Cosmetic Dentistry
Modern cosmetic dentistry is one of the most desired dental services. What it can do for a smile is hard to describe in words and the value is difficult to measure. To most people the effect on ones health, appearance, and self-esteem are priceless.
Most insurance companies consider cosmetic dental work a luxury and do not include it in their coverage of benefits. This is not unusual in the health care field. Few, if any, medical policies cover elective surgery. The rare exception to this rule is in an accident case where cosmetic work is in line with cor≠recting trauma.
Patients should be aware that even cosmetic dental procedures that are used to treat existing decay may not be covered under some dental plans. Many of these procedures (such as CMBRs), although used sucessfully for over a dozen years, are still considered "new" or "optional" by some insurance carriers and are not covered.
Fees charged for cosmetic procedures are generally higher than those for regular fillings and for maintenance care. These higher fees reflect the enormous amount of training and of time these procedures take to complete properly. In addition the materials and laboratory costs for cosmetic work are greater. Our primary concern is to provide you with the finest result possible. We feel your smile is worth the extra effort.
Many insurance companies that do claim to cover cosmetic procedures do so by allowing a very low reimbursement for such services. Though any assistance is welcome, the patient should not expect the major portion of these services to be covered by an insurance carrier.
As always, our staff will be happy to assist you in filing your dental claims. However, please remember, regardless of insurance coverage, the patient is fully responsible for the fees associated with their dental care.
Why Even Have Dental Insurance?
Selecting and paying for your own dental insurance policy is a poor investment for most adults, since premiums are lost in years of no treatment and cannot be recovered. If your employer pays for your dental insurance, you should be glad that at least small costs can be recovered.
Learn about Direct Reimbursement