• Fact 1 – DENTAL INSURANCE IS A CONTRACT BETWEEN YOU, YOUR EMPLOYER AND THE INSURANCE COMPANY. Dentist is not a party to that contract.

• Fact 2 – DENTAL INSURANCE IS NOT MEANT TO COVER ALL FEES. It is meant to be an aid to your investment in your or your child’s dental healthcare. Some routine dental services are not covered by dental insurance.

• Fact 3 – FEW INSURANCE PAY 100% OF ALL PROCEDURES. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. Usually, only basic diagnostic and preventive procedures are covered 100%. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

• Fact 4 – FREQUENCIES & LIMITATIONS OF BENEFITS. The frequency of payment for some procedures may be limited by an insurance company. 

• Fact 5 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE. You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. This often occurs for instance with composite ”white” fillings or ceramic crowns. Many insurance companies will reduce the fee to what they would cover for a silver amalgam filling or base metal crowns and pay a portion of that lowered fee. They call this an alternative benefit.

• Fact 6 – DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED. When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). 

• Fact 7 – MANY DENTAL INSURANCE PLANS CARRY A "MISSING TOOTH CLAUSE". Members covered by a dental plan with a missing tooth clause means the dental insurance company will not cover the costs of replacing the tooth if the tooth fell out or was extracted before the current dental coverage started.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment