Your
Questions
The actual cost of treatment varies widely depending
on the procedures, as well as whether the services are
preventive, restorative or cosmetic. We believe that
our patients deserve the best care. For that reason,
we make every effort to present our patients with the
best dental solution possible for their individual situation.
Perhaps that’s why so many of our patients have
raved about their results: improved oral health and function,
and a better smile – all with financial payment
options and plans personalized for their individual needs.
Some of our patients have dental benefits. If you do,
congratulations! You are fortunate. We will help you determine
the coverage you have available. We provide professional
care to you, our patient. Therefore, the insurance company
is responsible to you – and you, the patient, are
responsible to the doctor. Our financial coordinator will
help in every way possible in filing your claim and handling
insurance questions from our office on your behalf. Here
are a few things you should know:
- Your dental benefits are based upon a contract made
between your employer and an insurance company. If you
have any questions regarding your dental benefits, please
contact your employer or insurance company directly.
- Dental benefits differ greatly from medical benefits.
In 1959, most dental benefit plans had a yearly maximum
cap of $1000. You’ll be surprised to know today
that the average dental benefit plan has a yearly maximum
cap of $1000. That’s right - there has been no
significant increase in the yearly maximum cap in 40
years! However, there have been significant increases
in your premiums. Dental benefit plans will never pay
for completion of your dental care, but instead, is meant
to assist you.
- Many people receive notification from their insurance
company that dental fees are “above the usual and
customary”. An insurance company determines their
reimbursement level by surveying a geographical area,
calculating the average fee, then determines that 80%
of the average fee is customary. Included in this survey
are discount dental clinics and managed care facilities,
which have severely reduced dental fees that bring down
the average. Any doctor in private practice will have
fees that insurance companies define as “higher
than usual and customary”.
- Many dental benefit plans tell their participants that
they will be covered “up to 80% or 100%” but
do not clearly specify the plan fee schedule allowance,
annual maximum or limitations. It is more realistic to
expect dental benefit plans to cover between 25% to 40%
of dental services. Remember that the amount a plan reimburses
is determined by how much your employer has paid for
your dental benefit plan. You will get back only what
your employer has put in, less the insurance company’s
profit margin.
- Insurance companies do NOT recognize many routine and
newer dental services.
- Our team members will gladly assist you in filling
out the necessary forms to maximize your dental benefits
and discuss your financial options. Most insurance companies
send direct reimbursements within two weeks of service.
Excellent dental care is available with or without dental
benefits. If you have any questions regarding our policy,
please do not hesitate to ask.
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