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An Open Letter About Dental Insurance

Dental insurance is a wonderful benefit and a great help for many people in paying for their dentistry. Some plans help a lot, some help only a little; it depends on the arrangement agreed to between your employer and the insurance company. Dental insurance is different from other types of insurance in several ways. Most types of insurance have a sizable deductible that eliminates coverage for small claims. These insurances are designed to help cover large, unexpected expenses. Dental insurance, on the other hand, has a small deductible, covers the smaller procedures to a great extent, but covers the larger procedures to a lesser extent. For example, routine dental cleanings might be covered at 100%, fillings at 80%, and crowns or bridges at 50%. There is also a yearly maximum of typically between $1000-2000 (which hasn't changed since the '60s).

In order for the employer to save premium expense, insurance companies offer certain exclusions. A policy might be written with no benefits for bridges, which are used to replace missing teeth, or no benefit for periodontal (gum) treatment. These exclusions have nothing to do with the dental needs of the patient. It doesn't matter how badly the patient may need the treatment; if it's not in the contract, it's not covered. It's tempting for patients to say they only want treatment that's covered by their insurance. However, it's important to understand that the insurance plan was not written with any patient's best interest in mind. Limiting treatment to what the insurance covers may be hazardous to you health.

Insurance In Our Office

We understand the importance of insurance coverage in making dental care affordable with our patients, and we do our utmost to help patients find treatment options that align with this coverage. However, we make our treatment recommendations based upon patients’ needs and the highest quality treatment that will offer durable and long lasting results that look and feel natural. The benefits of any dental insurance plan are significantly limited based on the contract between your business and the insurance provider, and coverage is further limited based on the contract you sign with your employer. Every insurance plan is completely unique, and if you’re concerned about coverage limitations, we recommend addressing these concerns with your employer or human resources department.

Some plans offer or require a pre-determination of benefits prior to beginning a course of treatment. We will submit the appropriate forms to your insurance company. The insurance company will return the forms explaining the amount of coverage for your treatment. There is usually a three to five week turnaround time for these forms.

Dental insurance typically covers 50% to 80% of the cost of dental treatment. There is usually a deductible and a yearly maximum that also apply. Some policies state they cover a percentage of the "usual and customary fee" for a specific geographic area.

However, they are the ones who set these fees and determine the areas to which they relate, and they may not always be the same as the fees charged by this office. We will provide all the assistance we can in seeing that you receive the maximum benefits your insurance plan allows, but we have no control over what those benefits are. We will do our best to see that you receive your full benefits within the structure of your particular plan.

Changes in Health Insurance

Everyone is aware of the changes going on in health insurance these days. Insurance companies are under pressure to lower premiums. They in turn pressure the providers to accept reduced fees. The providers are then under pressure to alter the way they provide care in order to balance the fee reductions with the economic realities of staying in business. Some of the consequences in medical care delivery are staff reductions (specifically hospital nurses and support staff), hospitals buying physicians private practices, referrals to specialists are monitored, and everyone (doctors, hospitals, and patients) are answerable to the insurance companies.

These trends in medicine have also impacted dentistry. Dental insurance has always been inexpensive in comparison to medical insurance. There has always been an annual maximum benefit (which hasn't changed in 20 years), and usually involves a deductible and a patient co-payment. Never the less, insurance companies are applying the same pressures to dental practices. In an effort to reduce premiums, insurance companies are approaching dentists with a deal. If the practice agrees to a substantial discount in fees, those insured by the plan will be allowed to go to that practice for treatment. Perhaps "allowed" is misleading. Of course you can go to whatever office you choose, but there will be less insurance benefit if the office is not on the list.

There is pressure on the practice to join. No dentist wants to loose patients, particularly people we have known and cared for over many years. Joining such a plan means the practice must decide how to compensate for the fee reduction. Do you charge everyone else more, do you lay off staff, use cheaper supplies or labs, squeeze more patients into each day? These are not easy decisions, and none of these changes improves quality of care.

What is currently happening, and what you will see more of as time passes, is that dental practices will define themselves in one of two ways, based either on quality or on price. To try and find a middle ground is like standing with one foot in the boat and the other foot on the dock.

Our practice is and always will be dedicated to quality care for all our patients. We always look for value, but we will not sacrifice quality. We have an excellent staff, we demand excellence from the labs we use, and we do not cut corners on techniques or materials. We see this as part of our commitment to you as our patient. We will always stay current through continuing education, to allow a reasonable amount of time for every patient, and to stand behind the treatment we provide.

If your insurance is changing and your new plan restricts you to offices on a list, your recourse is to communicate with your employer that you want a plan that allows you to take your benefit, whatever it may be, and seek treatment at the office of your choice.

In order to practice with these ideals, we are very selective regarding the insurance plans with which we participate. We hope you'll understand.