Pike Dental believes that its patients deserve to have choices for dental care regardless of what their insurance contract covers. Frequently patients are disappointed when they learn that the procedures they desire are not covered by their insurance program. They are especially troubled when they learn that their insurance always has a co-pay and a maximum annual benefit of approximately $1,000. As explained in Dental & Medical Insurance later in this section, dental insurance programs do NOT cover 100 percent of the basic dental care recommended by the American Dental Association.
To deal with this disparity, our office offers a variety of methods for payment from which our patients may choose, either singly or in combination. They include:
For patients who need to pay for their services over an extended period of time, we also accept:
Care Credit
We help patients apply for financing through this program which provides interest-free loans for up to one year, depending on the amount borrowed.
Dental Insurance
To many dental patients, the subject of insurance is confusing and exasperating. Few patients have a proper understanding of the benefits to which they are entitled, and even fewer understand how cosmetic dentistry or periodontal procedures fit into the overall insurance picture.
There is a huge disparity between the basic standard of dental care as defined by the American Dental Association(ADA) and the less than basic level of care that may be covered under an insurance policy. While the ADA seeks compliance with its standard requirements, dental insurance companies only pay for the procedures and materials specified in a contract with employers. Most people are shocked to learn that they don’t have 100 percent coverage.
To help educate patients on these sometimes confusing issues, Pike Dental has listed below some of most frequently asked questions about insurance:
Q.
What exactly is dental insurance?
A.
Dental insurance is a contract between your employer and a dental insurance company. The benefits you receive from your policy are based on the terms of the contract negotiated between your employer and the dental insurance company selected by your employer. In virtually all instances, dental insurance provides only a partial allowance for basic care and some other specified dental services.
Q.
Is a dental insurance policy similar to a general health insurance policy?
A.
Actually there are major differences between the two. One of the most significant differences lies in the amount of coverage you can count on. In the case of dental insurance, even the most comprehensive policy will never pay for all of the dental service you receive. Dental insurance is an allowance rather than a pay-all proposition.
Q.
Why doesn’t our dental insurance cover all of our dental needs?
A.
Your dental plan is strictly a business relationship between your employer and the selected dental insurance company. The amount your plan pays is determined by the agreement negotiated by your employer with the insurer, and, of course, the negotiating parties have no knowledge of your dental needs. In most cases, the dental benefits you receive are mediated by your company’s human resources representative and the dental insurance agent. Cost, not dental care, is always the prime consideration. ADA recommendations for basic care are not a significant factor in these bargaining sessions. Essentially, your dental coverage is determined not by your dental needs—but by how much your employer contributes to the plan. And like automobile insurance, there is always a deductible negotiated up front. No dental insurance company pays the whole cost.
Q.
Who decides how much will be paid when insurance is involved?
A.
The insurance company does. Typically, a dental insurance company will survey a geographical area and calculate an “average fee” for dental services within that area. Then, the company will take 50-80 percent of that fee amount and declare it “usual and customary.” Anything above that “usual and customary” figure is not paid. Insurance companies consider this to be the patient’s co-payment. They also will reduce the patient’s benefit by an annual deductible.
Q.
Does this mean that typical fees for cosmetic dentistry services will not be covered by dental insurance plans?
A.
Unfortunately, when insurance companies calculate the average fee for a geographical area, their calculations are based on the lowest common denominator for dental services. For instance, they include the lowest cost, lowest quality dental materials, and of course, they include the services provided by discount dental clinics and managed care facilities. As you would expect, a cosmetic dentistry practice normally will exceed the “usual and customary” fees established by dental insurance companies because only the highest quality, longest lasting materials are used.
Q.
How do you work with patients who have dental insurance policies?
A.
We do everything possible to help you bridge the gap between what you want as our patient and what your insurance will pay for. our staff is experienced in helping patients understand and optimize their dental insurance benefits. Once we have a clear understanding of the insurance benefits available to you, we are able to customize payment options to fit your particular situation. These options include flexible plans ranging from No Interest to Interest Bearing lines of Credit. These options are explained in more detail under the heading of PAYMENT OPTIONS earlier in this section.
