Dental Insurance

Financing Your Care

Our recommended treatment will always be based on our professional expertise and what we believe is best for you, not on insurance coverage. 

As a courtesy to our patients, we will complete and file all insurance forms relative to dental services rendered except for HMO/DMO or Medicaid policies.  However, unlike medical insurance, dental insurance typically does not cover 100% of the costs incurred.  If requested, we will be happy to provide a complimentary estimate of benefits prior to treatment by contacting your insurance company to determine your benefits.   Please note that you must provide us with the most current insurance information for each family member before the forms can be submitted.  This sounds simple, but it is not.

• Insurance is complicated
• It is different for every patient
• Policies and coverage change frequently 

During the course of treatment, you will receive monthly statements from our office, regardless of your insurance coverage.  Patients will be expected to begin payment on the projected balance at the time treatment begins. 

Variables in insurance coverage 

Many of our patients have dental insurance.  Dental benefits can vary widely from company to company and from policy to policy within the same company.  While some policies cover the full cost of the treatment we provide, others cover very little.  Some policies provide full or near-full coverage for some treatments, and very little or no coverage for other treatments for the same patient.  There are many variables, but some of the most common are:

• “in network” or “out of network”
• “basic coverage”
• “participating” or “non-participating”

What do “in” and “out of” network mean?

For some insurance companies, it does not make a difference if our office is “in” or “out of” network, but for other companies, going “out of network” does make a difference.  The difference lies in the insurance company’s “allowable fee”.  The “allowable fee” refers to the amount your policy pays for a specific treatment. 

Your insurance company or your employer may say you have 100% coverage for preventive care. That means 100% of the insurance company’s “allowable fee.”  The “allowable fee” is the limit your policy will pay.  Sometimes the “allowable fee” is more than our fee, and sometimes it is less. 

For example: If our fee for a procedure is $100 and the “allowable fee” on your policy is $120, the insurance company will pay $100, and the patient does not owe any co-pay.  However, if our fee for a procedure is $100 and the “allowable fee” on your policy is $85, the insurance will pay $85, and the patient will have a $15 co-pay due to us.

What does “basic coverage” mean?

Some policies have “basic coverage”; others do not.  “Basic coverage” provides minimum insurance coverage.  Restorative treatment, such as “fillings,” is addressed in “basic coverage.”  For many insurance companies, “basic coverage” for a filling only covers the fee for an amalgam filling (also known as a Mercury or silver filling) or a lower-priced material, regardless of the type of material used to restore the tooth.  Basic coverage policies will only pay for the least expensive materials and not necessarily the best materials to restore your teeth to proper function.  At our office, we feel strongly that the materials we use on our patients must be of the highest quality and longest-lasting.  We use composite resins or porcelain to restore teeth because of the compatibility, longevity, and esthetic quality of these materials.  All of our recommendations are based on what we believe is the best material to restore the tooth or teeth to proper form and function, not on what the insurance company pays for.  

What does “participating” or “non-participating” mean?

If a dental office participates with an insurance company, the office accepts the insurance payment as full payment for treatment.  If a dental office does “not participate,” the office accepts the insurance payment as partial payment, and the patient is responsible for the remainder of the fee. We do not participate with any Dental Insurance companies.

Why doesn’t our office participate with my insurance company or accept HMO/DMO policies?

We have found that being bound by the provisions or limitations of insurance contracts can impact the quality of care our patients receive.  The benefits allowed by an insurance company are determined by what the employer purchases as coverage for its employees.  Unlike medical insurance, there are no laws that mandate adequate dental care coverage.  When insurance companies discount fees to the extent that many do, it adversely affects the quality of materials and labs a dental office can use, the amount and quality of the education we receive annually, as well as the ability to purchase and update our equipment to continue giving our patients the very best service and results that dentistry has to offer.  We feel that our patients’ overall health is much more important than allowing the insurance company to dictate their treatment choices based on cost rather than quality. 

Please remember that your policy is with your employer and your insurance company.  Our office has no control over your benefits.  We will, however, make every effort to get the maximum coverage your individual policy allows for service.  We will also work with you to tailor a treatment option that both fits your time and finances.  But in the end, our recommended treatment will always be based on our professional expertise and what we believe is best for you, not on insurance coverage.   

We hope this clarifies our office policy regarding dental insurance.  If you have additional questions please feel free to call our office.  We will be happy to help you.