Understanding Your Dental Benefits

  • The difference is that dental benefits are not designed to cover the entire cost of diagnosis and treatment; it is designed to help reduce the cost of some of the diagnosis and treatment of some procedures. Why is that? Quite simply, dental health is viewed more as a luxury and not as a necessity by insurance companies.

Dentistry does not have insurance. Dentistry has benefits.

Providers who are contracted with dental insurance companies, and who write the dental benefit contracts, are legally bound to the fees the insurance company dictates. What we must charge our patients who have their policies is also dictated by dental insurance companies. Insurance company's fees average about 30%-50% of what would normally be billed for a particular procedure. Additionally, what percentage a patient must pay and which procedures are covered are all dictated by the legal contract between the patient and the insurance company. For the 98% of our patients whose insurance we participate with, the fees, procedures covered, and percentage of out of pocket cost to the patient for any given procedure is legally controlled solely by the insurance company. With regard to participating insurance companies, our office has no control over what we can or do charge.

The cap of dental benefits has changed little in the past 40 years as medical costs have skyrocketed. Even with a few simple or routine procedures, it is very easy for a dental treatment plan to exceed the maximum allowable benefit allowed by a patient's insurance company. In these situations we remind our patients of two important facts.

  1. Although their insurance company may pay nothing, as a result of using up benefits on prior procedures, the patient still benefits from using the insurance companies fees. These fees are a 30-50% discount from our normal fees.
  2. A decision to not complete a procedure or treatment plan because insurance benefits have been used up is almost always outweighed by the risk of pain, increased morbidity, and almost always significantly increased cost and time. Taking advantage of an insurance company's mandated reduced fees, even without any remaining dental benefits, it's nearly always the best choice.

Evidence Based Dentistry

We want to remind all our patients that neither insurance companies nor insurance benefits dictate how we practice dentistry. Our sole dental purpose is to provide the best possible care to our patients. Our doctors have no knowledge of any one patient's financial contract or lack of contract with a third party. As doctors, we feel very strongly that all our patients be offered every viable treatment option, with the risks and benefits explained thoroughly, and then the treatment decision be left up the patient.

Our dentistry is evidence based, not insurance based.

We understand that patients have different priorities and budgets. For this reason, we have treatment plan coordinators whose sole job it is to help guide our patients through the financial jungle of dentistry. Our coordinators help patients understand what benefits they have, what treatment options are viable, and which will work best. Before patients leave, they will have a treatment plan complete with costs, any referrals that may be needed, and a rough timeline.