The Truth About Dental Insurance

Dental insurance may be one of the most frustrating topics for any dentist to discuss. It often becomes a road block in providing patients with the highest standard of care. People who do not have dental insurance often neglect dental care due to cost or limited access to providers. Dental insurance is a contract between you, your employer and the insurance company. Dental offices assist patients with their insurance by filing claims and providing estimates for treatment.

Most insurance plans have a maximum yearly allowable amount of around $2000.  This maximum has been the same since the early 1980s, while the cost of dental supplies, dental procedures and dental education has increased. Dental insurance is not so much of a help since the fee for 1 crown in our area at the 80th percentile is $1250.  I like to say that medical insurance usually kicks in when you need it the most, whereas dental insurance runs out when you need it the most.

One of the most frequent questions I hear in my office is,“What does the insurance cover?” I wish this was an easy question to answer, but unfortunately it is not.  There are hundreds of different insurance companies and thousands of different groups within those insurance companies, making it virtually impossible to obtain a complete benefit summary.  Furthermore, there are exceptions, frequency limitations and exclusions that are either in fine-print or not provided to the dental office when a benefit summary is requested.

Unlike medical insurance, the majority of dental insurances do not require a pre-authorization for dental work. Dental insurance companies determine a patient's benefits AFTER the work is completed and the claim is received. Just listen to the insurance company hold music, read the back of your insurance card or skim the bottom of a benefits eligibility fax, it reads: this is not a guarantee of payment; benefits will be determined after the insurance company receives a claim.

For these reasons, we provide our patients with an ESTIMATE of coverage.  We try our best to make sure that our estimate covers any insurance exceptions or limitations so that the patient has a better understanding of what his/her out of pocket may be. Ultimately, it is the patient's responsibility to read and understand his/her insurance benefits.

Insurance companies should not be considered a friend or foe.  The simple truth is that insurance companies are a for-profit business and exist to make their stockholders' a return on their investment. If they determine that a patient is ineligible for a service, that only means they will not pay for the service. It does not mean that the service is not dentally warranted. Sometimes patients misunderstand that if their insurance doesn't cover a service, then they don’t need the service. Please remember that it is up to the doctor to diagnose and treat patients on what they need- not what their insurance may or may not cover. Often times, dental insurance companies will provide a benefit for the least-costly option, which is rarely the best dental option for the patient.

At Roselle Park Dental, our mission is to ensure the genuine comfort and care of our patients. We pledge to improve both the dental and total health and wellness of our patients. We are here to treat you as a patient and not let insurance companies dictate the quality of care we provide.