Dental insurance is rapidly playing a larger role in helping people obtain dental treatment. Since we strongly feel our patients deserve the best possible oral health care we can provide, we would like to share some facts about dental insurance with you in an effort to maximize the quality of care you choose and desire.
You may receive a letter from your insurance company stating that dental fees are higher than “usual and customary”. An insurance company surveys a geographic area, finds the average fee, and then takes 90% of that fee and considers it customary. Included in the fee survey are discount clinics which will bring down the average. Any doctor in private practice will have fees that are considered higher than average.
Dental insurance is not meant to be a PAY-ALL, it is only meant to be an aid. Most patients only have $1000 to $1500 of annual coverage.
Many plans tell their insured that they’ll be covered “up to 80% or up to 100%” but do not clearly specify the plan fee schedule allowance, annual maximum, or limitations.
We have found that most plans cover about 35% to 65% of major services based on the plan’s pre-established maximum fee allowance which varies from carrier to carrier.
It has been the experience of many dentists that some insurance companies tell their insured that dentist’s fees are “above the usual and customary fees” rather than saying “our benefits are low”.
The amount your plan pays is determined by how much your employer paid for the plan. The less he/she paid for the insurance, the less and fewer benefits you will receive. Remember you get back only what your employer put in less the profits of the insurance company.
Many routine dental services are NOT covered by insurance carriers. In addition, many of dentistry's latest technological advancements are also NOT covered by insurance carriers.
The primary objective of an insurance company is to make a profit for its shareholders. Our primary objective is to help you enhance your oral health and wellness, to provide the services that are best and most appropriate for you.
Insurance carriers are more profitable by limiting procedures to minimal repair with ordinary materials. They are committed to a standard of adequacy, while we are committed to a standard of excellence and “optimal care,” which means we would not do anything for you that is less than what we would want for ourselves or our families. Our commitment to excellence goes far beyond just being “good enough” or “clinically acceptable,” and we choose to use state-of-the-art technology and materials which are superior to “usual and customary.” Consequently, our fees are often beyond what the carrier allows.
Twenty-five years ago, the average maximum benefit per year was $1,000. If the insurance benefits had kept up with inflation, the maximum per year benefit would be approximately $5,000 today. At present, the average maximum benefit per year is still $1,000 – this is equal to about $165 in 1971 dollars. This does not detract from the value of your dental health insurance. We are pleased to help you receive your maximum allowable benefit within our commitment to exceptional service and optimal care.
Please do not be hesitant in asking us any questions about our office policies. We want you to be comfortable in dealing with these matters, and we urge you to consult us if you have any questions regarding our services and/or fees. We will fill out and file insurance forms at no charge. We will do all we can to assure you of maximum benefits.
If you have any questions regarding your insurance, we ask that you contact your company regarding the specifics and details of the plan it is conducting on your behalf.
