We are often put in the uncomfortable position of ‘middle-man’ in the relationship between patients and their insurance companies. We decided to devote this Newsletter to answer and explain some of the questions we are frequently asked about dental insurance and our office insurance policies.
Dental insurance can help many patients reduce their cost of dental treatment, but very few dental benefit plans are designed to cover ALL of a patient’s dental costs. Dental insurance does not assume any responsibility for the actual care of your teeth. In order to receive the best care, patients should consult with their Dentist and take personal responsibility for their own dental care and maintenance. In order to avoid surprises, it is important to understand the portion of treatment costs your insurance will cover. Your dental insurance coverage should not be confused with the dental services that you would most benefit from or need.
How Dental Plans Work
Dental plans are a contract between your employer (or you) and an insurance company. Your benefits are determined by how much coverage your employer (or you) wish to purchase through the insurance company. Often times, this coverage does not match what the patient needs or would most benefit from. Most insurance companies have an annual deductible and maximum that can be used each year toward dental treatment. Each insurance plan also has exclusions in which they may opt not to cover certain conditions or procedures.
The Role of Your Dental Office
Our job is to help you take the best possible care of your teeth. We strive to offer the best treatment options, which at times may be different from what your insurance covers. Whenever possible, we try to obtain a pre-treatment estimate on your behalf; in order to approximate the amount that your insurance will pay toward your dental treatment, and the portion which will remain as your responsibility. As an additional courtesy to you, we gladly bill your insurance claims as your treatment is being provided.
The insurance company may want you to choose dental care from a list of preferred dentists who they have an existing contract with. The term “preferred” has nothing to do with the patient’s personal choice of a dentist, but instead refers to the insurance company’s choice of dental office. If you choose to receive dental care from outside the preferred provider group, the insurance company will penalize you financially with higher out-of-pocket costs, in an effort to have you see one of their preferred providers. Nationwide, there are over a hundred different Dental Insurance Companies. Each insurance company attempts to entice dentists with the promise of an additional pool of new patients, in exchange for a lower fee schedule for their contracted patients.
The Skyline Dental Philosophy Throughout our history, we have opted to not join any Preferred Provider Plans for the following reasons:
- It has kept life simple for us, by allowing us to have one fee schedule for our entire practice. Our fee schedule happens to be the ODS Usual, Customary & Reasonable Fee Schedule for our region and state. We do not vary our fee schedule from patient to patient.
- We strive to provide the same quality care to each and every patient, regardless of whether they have dental insurance or not. A common routine amongst practices with multiple fee schedules is to offer decreased service or quality to the patients who have a smaller reimbursement rate through their insurance plan. We believe that each and every patient should receive the same exact level of service and quality care that we render to our own families.
- Over the years, our practice has been stable and successful through word-of-mouth referrals of our existing patients (THANK YOU). We have tried to establish a personal relationship with each and every one of our patients. We feel that this connection and commitment to the patient is more conducive to providing excellent patient care, than a contractual business arrangement provided and arranged by an insurance company for the sole benefit and profit of the insurance company.
Your Dental Health is our Top Priority Although it’s tempting to decide on dental care based on what insurance will cover, always remember that your dental health and smile are more important than anything else. Hopefully, we have explained that dental insurance is a benefit designed to help with a portion of your care, and is ultimately a contract between your employer (or you) and the insurance company. We will always strive to provide the same consistent service and high level of care to each and every one of our patients, regardless of whether they are a fee-for-service patient or one with dental insurance.
(Excerpts from the American Dental Association and Academy of General Dentistry Websites)