DENTAL INSURANCE AND HOW IT WORKS
The contract between your employer and the dental insurance company determine your dental benefits. The benefits are not negotiated with the dental office. Most dental insurance policies only provide basic care for specific dental services. Based on the cost of the policy to your employer and the negotiated arrangements with the dental insurance company will determine those specific dental services. As these benefits are decided between your employer and the insurance company, many services are not covered. It is based on the contract with the insurance company.
Rarely do dental insurance companies cover 100% of any dental fee. In most cases, dental insurance companies cover less than 50%, if nothing at all.
Covered and Non-Covered Services
We are committed to help you achieve and maintain optimal dental care. Unfortunately, your dental insurer may not cover the services that you need or want. Dental insurance companies only provide the negotiated benefit for the specifically selected services.
Your dental insurance company’s reimbursement process is a mathematical formula as to which benefits your will receive and the percentage of the dentist’s office fee that will be paid. Please be aware that each dental insurance plan has a dollar amount limitation each year. Once this limit is reached by the patient, regardless of how essential the service may be to your health, no services will be covered by your dental insurance company.
How We Can Help
We will assist you to understand and make the most of your dental insurance benefits. We will provide you full assistance as we realize that dental insurance is complex and difficult to understand how it works.
We will complete and submit dental forms to your dental insurance company to achieve the maximum reimbursement to which you are entitled to as quickly as possible. Some dental insurance companies may take longer than others to complete payment. In some circumstances, we may request your assistance in this matter.
Pre-Determination Policies
Authorization for procedures in advance may be required by your dental insurance company. They try to control the amount of dentistry you receive. We will assist to help you maximize the insurance benefit to which you are entitled.
On most occasions, prior to receiving authorization from the dental insurance company, we can begin treatment. However, patients need to be aware that in the event the dental insurance company refuses to pay for treatment, the patient is responsible for all fees. Naturally, all treatment fees will be discussed with the patient in advance.
Elective Treatment
Cosmetic dentistry, implants, occlusion or bite redesign as well as other services are not typically covered by dental insurance companies. Although these services can greatly enhance the quality of life of patients, dental insurance companies rarely include in contracts with your employer.
We Are Available to Help Anytime
Please feel free to call us with any questions you may have about your dental insurance as we realize how difficult and complex it can be to understand. Dental insurance companies are continually making changes in order to reduce costs. Please note that dental insurance companies are more concerned with providing coverage for only a limited number of basic services and not concerned about coverage for optimal dental care.
Our Philosophy
Our goal is dedicated to providing optimal care for every patient. We will provide the quality of care you have been accustomed to and will help you in any way.
It would be our pleasure to help. Please contact at 219-755-0123 with any questions.