Insurance

Do you take my dental insurance?

We accept all dental insurance coverage. However, it is important to know that dental insurance is an assistance program only. Unlike medical insurance, dental insurance only pays a certain percentage of each procedure. Dental plans are designed to save in the cost of your dental care, not to completely pay for those costs. Almost all dental benefit plans are the result of a contract between the plan sponsor (usually an employer or a union) and the third-party payer (usually an insurance company). The amount your plan pays is determined by the agreement negotiated by your employer with the insurer. Your dental coverage is determined not by your dental needs, but by how much your employer contributes to the plan.

Annual Maximums

Most dental programs have an annual dollar maximum. This is the maximum dollar amount a dental plan will pay toward the cost of dental care within a set benefit period. The patient is responsible for paying cost above the annual maximum. Even though the cost of dental care has significantly increased over the years, the maximum levels of insurance reimbursements have remained the same since the late 1960s.

Pre-existing Conditions

Just like medical insurance, a dental plan may not cover conditions that existed before the patient enrolled in the plan. This includes plans that have "missing tooth" exclusions. Although when your employer decides to change the company that your insurance is with usually does not apply.

Treatment Exclusions

A dental plan may not cover certain procedures or preventive treatments. Some plans exclude certain dental treatments such as sealants, implants, pre-existing conditions, adult orthodontics, specialist referrals and other dental needs.

Plan Frequency Limitations

Certain procedures may simply not be covered as often as necessary for optimal oral health. A common example might be a plan that pays for teeth cleaning only twice a year even though a particular patient may require cleaning every three months. Other plans, for instance, will only pay for sealants once in a lifetime, when generally sealants only last between 5 and 10 years.

Comprehensive Alternative Treatment

The dental plan may only allow benefits for the least expensive treatment for a condition. For example, the dentist may recommend a resin composite filling of a posterior tooth, but the insurance may only offer reimbursement for a silver filling. As in the case of exclusions, patients should base treatment decisions on their dental needs, not on their dental benefit coverage. In many instances, the least expensive alternative is not always the best option.