Dental Insurance

In 1965, 2 million people were covered by dental insurance. Today, that number is approximately 33 million. Yet dental insurance plans have not kept up with either demand or 40 years worth of cost-of-living increases.

Although our teeth play a fundamental role in our lives, dental insurance often does not provide the kind of coverage one would expect. We feel the best thing you can do as a dental patient is to stay informed about the details of your particular plan. We will do everything we can to help you get the information you need.

Important Information about Dental Insurance

* Many patients think that their dental plan pays 80-100% of their dental costs. We’ve found that many plans actually cover about 40-50% of an average fee.

* Insurance coverage is a matter between your employer and the insurance company. We are not involved with any insurance company; therefore your benefits are not determined by our office.

* Please read your policy so that you are aware of any limitation of benefits provided. Some routine services and preventive procedures are not covered by insurance. We will cooperate in any way to help you obtain the maximum benefit from your insurance coverage.

* We will be happy to fill out your insurance forms and submit the claims to your insurance company. It usually takes three to six weeks for benefits to be paid. If after sixty days your insurance company has not paid, we ask the patient to pay the balance of their account. We will continue to seek settlement from your insurance company for a reasonable period of time.

* Insurance claims are submitted after each visit.

Dentistry Estimates and Insurance

We can make no guarantee of any estimated coverage, but we'll do our best to see that you receive your maximum benefits. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. If you would like to know what your expected coverage will be, we will submit a pre-treatment estimate. Your insurer will generally send a detailed response within 4-6 weeks.

Cosmetic Dentistry and Insurance

Cosmetic procedures are generally not covered by most dental insurance policies; however, partial benefits are often available if the teeth are broken or have previous dental fillings, bonding, or crowns. Also, most insurance companies will pay approximately 80% of the cost for silver fillings on posterior (molar and bicuspid) teeth. If a more expensive porcelain or tooth colored filling material is used, the insurance company usually still pays their percentage based on the cost of the less expensive silver filling.

Please remember that patients are responsible for any costs not covered by their insurance.

The three most popular forms of dental insurance

	Traditional Indemnity Dental Insurance	Professional Provider Organization (PPO)	Health Maintenance Organization (HMO)
	These plans were the original dental benefit plans that have provided good dental coverage for decades. This is the best of all 3 plans.	These organizations provide dentistry through contracted dentists who agree to accept lower fees.	Minimum dentistry is provided through contracted dentists who agree to small monthly capitation payments for each employee/patient regardless if services are performed or not.
Patient's Freedom of Choice	Patients choose their own dentist. (Greatest freedom of choice)	Patients have more freedom of choice than with an HMO, but pay more for care from a non-preferred provider.	Patients are restricted to a list of designated providers. (Least freedom of choice)
Benefits	The levels and coverage are defined by a contract, and generally provide more comprehensive services than PPOs and HMOs.	Enrolled members receive services at a reduced cost when the services are delivered by a preferred provider.	Enrolled members receive minimum comprehensive services when care is provided by a plan provider.
Utilization	May or may not be controlled by the carrier.	Less controlled than an HMO.	Providers receive a financial incentive to control utilization.
Payment to the Providing Dentist	Dentists are paid (indemnified) for services by the insurance company and the patients.	Dentists are paid on the basis of a discounted fee schedule.	Dentists are paid a small dollar amount per member per month regardless of services rendered.
Cost to patient	Usually the most expensive.	Less expensive than an indemnity plan.	Least expensive.

Table copyright owned by and reproduced with permission of KISCO

Mark R. Colin, D.D.S.

General Dentistry, Fort Lauderdale, Florida