WHAT YOU NEED TO KNOW ABOUT DENTAL INSURANCE

 

Is Dental Insurance like Medical Insurance?

The California State Dental Society created the first dental insurance in 1961. By designe it was never meant to mimic medical insurance. Dental insurance is structured to cover only a portion of employees’ dental expenses. It was never meant to cover all dental expenses as most medical plans do.

As a matter of fact, in 1961, the first annual maximum dental benefit, per person, was $1000.  As you may know, that is still exactly the same in most policies.  Thirty years of inflation… yet the “per person benefit” has never been increased.  It is easy to see that $1000 is a nice contribution from your employer, but it should not be considered “the ceiling” which keeps you from achieving the best dental health.

In our office we look at dental insurance as a delightful “gift” from your employer and we will always help you maximize your policy’s benefits.

If my insurance doesn’t cover a procedure, does that mean it’s not necessary?

Your dental insurance is simply a contract between your employer and the insurance company.  Your coverage is determined by how much your employer was willing spend when they negotiated with the insurance company.  Basically, there is a “laundry list” of covered and non-covered procedures, and this list has absolutely nothing to do with the need or importance of any given procedure.  In most policies, there are important procedures that are not designated as covered treatment, simply because your employer did not negotiate that level of coverage for you.

If you are reading this material, you are probably someone highly interested in their dental health and the cost of health care for your family.  You may be surprised to know that a large percent of Americans never visit a dentist or do so only in severe emergencies (about 40%) These people often have dental insurance!

This is exactly where the insurance companies make money: Your employer pays for a policy that will cover everyone, and the insurance company makes money when a number of people do not go to the dentist. Based on this arrangement, it is better for the insurance company to have fewer people going to the dentist and/or limitations placed on the dentist for the kind of care he/she provides.

What is a “preferred provider” and why isn’t our office on your insurance company’s list?

Most of the plans that use these labels are “managed care” policies…or are very nearly as restrictive. To become a “preferred provider”, the dentist signs a contact with the insurance company and accepts restricted fees. The dentist must accept these restricted fees. The dentist must also agree to comply with the insurance company’s rules about methods of practice and treatment limitations. In exchange for accepting these particulars, the dentist’s name gets put on a list that is often promoted a “special or select” group. Sometimes when the insurance companies are marketing their policies they make the “preferred providers” list sound as if it is an indication of higher quality dental care.

But to make no mistake… it’s simply a business contract signed between the insurance company and the dentist. We have never seen any part of such an arrangement that verifies quality of care.

Because these policies, in some way, restrict and/or control the way the dentist delivers care or does business, it forces us to treat some patients differently than others. Some dentists hesitate to start down that kind of slippery slope. Our doctors are party (an insurance company) to influence the quality of your care like this. It is an ethical question that each professional has to answer for him or herself.

What does it mean when the insurance company tells me my dentist’s fee is higher than “usual and customary”?

“Usual and Customary fees” are arrived at by averaging the fees of all of the dentists in a certain geographic area. Regrettably, these fees are evaluated very infrequently so they are not always a reflection of the current cost of providing care.

In addition, the statement “exceeds usual and customary” also implies that the dentist is overcharging, rather than indicating that the insurance carrier is under-providing. In fact, the extent of your coverage is simply based on how much your employer was willing to spend. If your insurance dose not cover the full fee for your visit, it may be that this was the intent… with coverage that is intended to be mediocre, the fees of any high quality dental office might look unreasonable, even if they just keep up with inflation annually.

Our fees are covered fully by any number of carriers. We would be happy to share our knowledge with your benefits coordinator.

A professional office infused with an air of excellence, at every angle, will be the place where most of us will want to be cared for:

• We find that a superb, long-term staff gives patients the best possible experience and it is well worth the added investment.
• We find that state of the art technology creates the best results for patients, and this level of technology can be very costly.
• We find that an exceptional facility creates a warm, personalized environment for care. 

In the final analysis, our hope is that you have experienced something unique and pleasantly different in your visit to Fiddlehead Family Dentistry. Our efforts to make your visit comfortable, fun and first-rate are unwavering. We are not a “usual and customary” dental practice… nor do we want to be.

Our Philosophy at Fiddlehead Dental?

To reiterate, we look at dental insurance as yet another “thank you” that your employer has given you for your tireless talents in your career. If it helps defray $1000, or more of the costs of your dental care or maintenance each year,… then you are very fortunate! (45% of our patients do not have insurance.)

In our practice, you will have some fantastic, experienced minds helping you make the most of your benefits. Currently, our front desk team has more than 45 years of combined experience working with all the various dental insurance companies.

In fact, we invite you to talk at length with Dr. Chuck or Dr. Lynda if this information leaves you with any questions.

From time to time patients will tell us that they “only want to do what the insurance covers.” It is important to understand that insurance companies are in the business of turning a profit for their stockholders. They are not in the business to see that you keep your teeth for a lifetime.

Our team at Fiddlehead Family Dental is in the business of building a relationship with you that can enhance your quality of life and improve your oral health indefinitely.

It is for this basic rationale that we do not let insurance companies influence or limit the quality of care we might recommend.

Frequently, a patient’s treatment needs exceed their annual benefit, and we help them with good financial arrangements: keeping the quality or our care constant, and making only the timing of treatment a variable.

This approach has proven to be a wonderful methodology for enhancing smiles, while respecting a family budget.

In our Fiddlehead Dental mission statement, we vow  “we will do our utmost to provide the level of care that helps our patients maintain the health of their smile for a lifetime.” This very firm commitment is the sieve through which we run all decisions.

We hope it matches the philosophy of care you are seeking.