There is a great deal of confusion about dental insurance. Please remember, we do not work for any insurance company or for any PPO or HMO. We work for you. Our treatment recommendations are based solely on what we feel will give you the best dental outcomes. Insurance companies’ treatment recommendations are based solely on what is best for their profit margins.
There are two methods commonly used by dental insurance companies to limit your reimbursement. The first is the payment schedule, which limits the amount covered for any particular procedure. Most of these benefit tables are based on faulty and outdated information and cannot be justified. An insurance company may also limit payment because they claim the fee was greater than the “usual and customary” charge for that procedure. Again, it is impossible to ascertain how the insurance company arrived at their “usual and customary” figures, which can be less than half of those found in nationally published data. Moreover, we are not satisfied with “usual” or “customary” and you can expect unusual and extraordinary care at our office.
The second – and most restricting – limitation to benefits is the yearly maximum payment the dental insurance company will reimburse. Regardless of the procedure coverage, most dental insurance companies will cap payment between $1000 and $2000 a year. Thus, if the insurance company’s scheduled re-imbursement for a $3000 procedure were $2400, they would still only pay up to their yearly maximum of, say, $1500.
While we are not directly involved with any insurance company, we will do all we can to help you derive maximum benefits from your insurance plan. For new patient consultations and dental cleanings, we provide “attending doctor” statements for you to attach to your insurance claim form. For more extensive treatment we will submit a pre-treatment estimate to your insurance company, when requested, to determine what reimbursement is available for anticipated services. After that treatment is completed, our office will then send in a final insurance claim for you.
We have a staff member who will help patients receive as much as possible from their insurance company, but remember this is done as a courtesy to our patients. Each patient is entirely responsible for his or her bill