Dental Insurance Plans
Dental insurance is a contract between an employer and a dental insurance company. The benefits that you receive are based on the terms of the contract negotiated between your employer and the dental insurance company, NOT the dental practitioner.
As the goal of dental insurance policies is to provide some level of coverage for specific dental services, the exact eligible services, level of coverage, and annual maximum are selected based on the cost of the policy to the employer. These policies are prepaid benefit plans designed to meet an employer's budget.
The lower the budget, the more restrictive the plan. These limitations and restrictions will almost always mean that your oral health will require your personal investment. For example, once the annual limit is reached, your insurance will cover no other services no matter how essential they may be to your oral health.
Unfortunately, your dental insurance may not cover some of the services that you may need or want. Dental insurance companies typically do not cover any cosmetic or implant-related services even though these are very important dental services that greatly enhance the quality of life for our patients. There are some patients that have "Flex" plans, such that benefits may be moved from one type of health care to another on a yearly basis, so as to increase available benefits when they are needed most. As well, sometimes there is a "Health Spending Account" that allows an employee to spend a fixed dollar amount any way they may need.
Our goal is to help you achieve and maintain optimum dental care, which is not the goal of your dental insurance company who only provides the negotiated benefits for specifically selected services.
We recognize that dental insurance can be complex and extremely difficult to understand. Therefore, we will do everything possible to help you understand and make the most of your dental insurance benefits. Please keep in mind that insurance companies attempt to reduce their costs through continuous changes, so please keep us informed of any changes to your benefit package as your insurance company does NOT inform us of any changes to your policy.
We encourage our patients to familiarize themselves with their dental plan in order to eliminate disappointments with payment and reimbursement. If we proceed with your necessary treatment because you assume it is covered, and then after claim submission you find out that your plan has changed and your treatment is denied, you will be disappointed.
It is impossible for us to know every patients insurance coverage details, especially when they do not inform us of their changes, so we need your help. We can best assess your coverage prior to treatment by first submitting a pre-authorization of the required treatment and the associated fees to see if your insurance company will authorize or deny the treatment.
Insurance companies have the contractual right to limit their liability for many of the more comprehensive dental treatments such as crowns, bridges, dentures, and orthodontics. This means that they require approval or pre-authorizations before they will reimburse you for select treatments.
We will prepare and send to your insurance company the diagnosis, x-ray or photo, and explanation as to why your specific treatments are necessary. On average, it can take two to six weeks to receive approval or denial from them. As soon as we receive the details regarding the coverage, we will contact you and explain it to you. In most cases, we can begin treatment for basic dentistry prior to receiving authorization and we will submit your insurance claim for you.
Patients urgently requiring major dentistry to relieve them of pain and discomfort cannot wait two to six weeks for approval. However, we can still proceed with treatment and submit a post-authorization claim for you with the attached evidence showing why you could not wait the approval time period, but we cannot guarantee that they will reimburse you.
We will not compromise your dental health care because of restraints placed by your insurance company. Our goal is to provide a high quality of dental care, and we feel that one of the key factors in achieving this goal, is to remain free of dental insurance involvement. Insurance companies are obligated to answer to your needs and questions, but they have absolutely no requirement to cooperate with dental offices. This is why we try to limit our contact with benefits providers for our patients, except when absolutely necessary.
It is for these reasons that we ask for payment directly from our patients. Our administration team has many years of experience with dental insurance benefits, and will work diligently at getting every benefit dollar contractually entitled to you.