Dental Insurance 101

Can I Choose My Dentist?

In recent years insurance companies both medical and dental, have made us all feel a little trapped. Premiums get paid every month for insurance coverage, whether by you or your employer. They periodically send out some massive textbook-like document that is supposed to explain who approved providers are and what services are covered. Yet, many, dare we say most of people are very uncertain as to who they can go see and what services will be covered.

This uncertainty has left many of us feeling unempowered when it comes to our dental care. So, we broke down a couple of important things to remember.

  1. THIS IS THE MOST IMPORTANT ONE! You are in charge of picking your dental provider! The current relationship between the people that need dental care out there and the insurance companies is dismal and extremely one-sided. First and foremost you should select a dental provider that works for you. Then, evaluate if they are in-network or out-of-network. Just because a dentist is out-of-network does NOT mean that can’t still be the best fit for you (even financially, see tips below…)  
  2. Dental insurance companies use what is called a Fee Schedule. Essentially, this is the amount that they will pay for coverage of any given service. It is what they allow. The fees “Allowed” by plans using a fee schedule are typically much lower than the actual fees at our office or any other offices in the area. This is what creates out-of-pocket expenses (sometimes significant ones) even if when you have insurance.

If you come to see us and you are “In-Network,” then any difference in the fee for any particular service, between what OUR fee is and what your insurance “Allows” for that service, is an amount our office has to write off.

If you come to see us and you are “Out-of-Network,” it simply means that if there is a difference between OUR fee and the allowable fee set by your insurance, you are responsible for the difference.

  1. Then, Why would I ever Go Out-of-Network?

For many patients using Out-of-Network benefits for preventative or diagnostic services, there is often $0 or a small out-of-pocket fee, even when out-of-network. How? Our procedure fees are based on “Usual and Customary Rates” for our area and are usually still within or very close to the Allowable Fees set by a lot of insurance companies who base benefits on those Usual and Customary Rates.

Also, keep in mind that out-of-network means you aren’t restricted to the insurance stipulations that are often in place (e.g. silver, amalgam crown on a back tooth instead of porcelain white)

Finally, even if you have an out-of-pocket expense, isn’t it better to be with a dentist that you trust and is the best fit for you (location, hours, comfort, and care etc.) regardless of the arbitrary list your insurance company selects for you…?

Tips to manage dental cost:

  • Ask us what financial options we have
  • Schedule treatment in phases
  • Subscribe to our Sweepstakes and win up to $1,000

Please, of course, remember that there are hundreds of different insurance plans out there all with different conditions and/or stipulations.