Dental Insurance is a highly complex area that creates confusion for many dental patients and dental offices alike.  The complexities of dental insurance and the lack of sufficient information provided by most insurance companies make it almost impossible for some patients to fully understand their benefits. What complicates the issue even more is that we base our recommendations on what we feel is best for your oral health.  Insurance bases their recommendations on what is best to lower the costs of reimbursement and how to show profits for their shareholders.  Remember, they are in the business of making money, not spending money.  You get back in benefits what your employer puts in, minus the insurance company profits.   Many insurance companies are in the midst of multiple lawsuits regarding how they administer plans, how they fix prices, etc.  Many of these companies have already lost these suits, but still do business in a fashion that a great number of dentists feel is unfair, restrictive, confusing, and lowers the bar for dental health.

The $1,000 annual maximum reimbursement established in 1967 when "dental insurance" was first created has not increased in over 40 years!  If they did keep up with inflation then your policy would be reimbursing approximately $12,000 annually for your dental care.  The dental insurance industry has been able to fly under the radar with this fact and kept their annual maximums at a present day average of $1,500.  Obviously this allows them to show great profit to their stockholders because the increase in premiums they have been collecting from you have kept up with inflation even though their reimbursements given back have not.

The dental plan selected by your employer was most likely based on the company’s purchasing power, not one designed with your unique dental needs and wants in mind.  Because the plan must apply to every employee in the company, it cannot possibly respond to the individual differences that undoubtedly exist in your group.  For that reason, we hope you come to look at your dental plan as a benefit from your employer to help defray the cost of some types of dental services and treatments.  It should never be a factor in making important decisions about your health.

My staff and I are dedicated to taking care of you with what we know is best for you, not your carrier. I do not diagnose, render treatment, or establish fees according to any insurance table of allowances or their interpretation of health.  Treatment and fees are based on the care, skill, and judgment of my dental team. I will not violate your trust by compromising recommendations and treatment based on the limitations of your coverage.  As long as I am the one rendering your dental care, my obligation is to you, not them.

Our office has always been happy to cooperate with patients who have dental insurance.  We think insurance is a great incentive to maintain a vital level of oral health.  But it is extremely rare that a dental plan will cover 100% of our fees.  Every insurance company have clauses in their contracts that limit benefits and change accurate procedure codes to alternative, less costly treatment that requires them to pay less and you to pay more.  These practices have nothing to do with your oral health or what is best for you.  They are solely based on your particular contract and “running the numbers” to make the contract attractive to your employer.  The reimbursements that company’s give usually has nothing to do with the real world of dentistry.  The figures are contrived, manipulated, and illegally claimed as usual and customary.  With one look at our office, at our latest state of the art equipment, and our advanced training—you will see nothing that resembles “usual and customary”.

We will always help you get the most benefits from your insurance carrier we can.  If you have any questions or concerns, please feel free to call us.

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