• Insurance Info

  • How Dental Insurance Works

    Dental insurance is often a source of confusion for patients. The complexity of dental insurance and the lack of sufficient information provided by some companies make it almost impossible for some patients to understand. Even more confusing is understanding how to properly work with your insurance company to achieve the highest level of benefits.

    Dental insurance is a contract between your employer and a dental insurance company. The benefits you receive are based on the terms of the contract negotiated between your employer and the insurance company, not the dental office. Because the benefits you have are negotiated between your employer and the insurance company there are often services that are not covered or are covered at a reduced fee/ alternate benefit. The selection of services covered is not based off of what you need or want, but is strictly on the contract with the insurance company.

    Often times your insurance policy will quote a percent of coverage for certain procedures. Realize that the % given is based on the usual and customary fees which are set by the insurance company and may not reflect current fees in an area. For example, many insurance companies quote 100% for preventative services but it is 100% of their allowances, not the dental office. Therefore the % of coverage is often less and there may be a balance remaining the patient is responsible for.

    Most insurance companies have an annual maximum, or dollar limitation they will pay each year. Once you have reached maximum no other services will be covered by your insurance company regardless of how essential the service may be to your dental health. While we strive to keep updated on your individual maximum remaining it is your patient responsibility to know the amount of your maximum remaining.

    How Our Office Helps

    Our office will do everything possible to help you understand and make the most of your dental insurance benefits. We will contact your insurance to verify your benefits and limitations, complete and submit dental claims for you. We also recommend requesting a pre-determination of benefits from your insurance company that will give you a better idea of your out of pocket expense prior to your treatment. Our office can file one for you upon request.

    Due to the nature of your insurance please be aware that there may be times in which your insurance company requires information directly from you or the subscriber. Some insurance companies take longer than others to process claims and issue payments, on the rare occasion your help is needed with payment processing and we may request for you to contact your insurance.

    Please remember you are fully responsible for payment regardless of your insurance coverage. Please bring all insurance information with you on your first visit.

    Our office is here to help you understand your benefits. Please ask if you have questions.