Do you ever wonder why you receive a bill from the dentist even though you have dental insurance and paid your co pay? Well I used to too till I became a dentist myself and was enlightened to the whole world of dental insurance. That’s why I thought I should help you understand this mystery a little better.
Let me clarify that dental insurance is a completely different animal from medical insurance. Some medical insurances will cover particular types of dental treatment like jaw surgeries, wisdom teeth extractions etc; but in general you cannot go to a dental office with medical insurance and expect to be covered for dental work. Dental treatment has it’s own separate insurance plans. Now why is it so difficult to understand dental insurance? Dental insurance is a very complex area creating confusion for many people. The lack of sufficient information provided by some dentists and some insurance companies, makes it almost impossible for patients to properly understand their benefits.
Dental insurance is typically a contract between your employer (this could be you if you’re self employed) and a dental insurance company. The benefits that you receive are based on the terms of the contract that were negotiated between your employer and the dental insurance company and not your dental office. The goal of most dental insurance policies is to provide only basic care for specific dental services. Well, what if you need some particular type of dental treatment according to your dentist and your insurance company does not cover it? Unfortunately dental insurance companies don’t look at what a person needs but go by what has been negotiated between them and your employer. Here’s an example. If a patient has a small cavity, I would do a white filling also called a tooth colored filling rather than a silver filling, because less tooth structure needs to be drilled, it’s a bonded filling giving a better seal, looks better, usually does not need any anesthetic injections making it painless, and I believe it’s a better restoration in the long run. For a silver filling the tooth has to be drilled more as it needs a certain depth even if your cavity is not that deep running the risk of making your tooth sensitive. Also silver fillings look ugly when you open your mouth. So given the choice I would do only tooth colored fillings as far as possible. It’s the better treatment for the patient. When most insurance companies say they cover 80% of fillings it’s usually the silver filling and you will have to pay your 20% plus the difference between the cost of the silver and white filling. That’s where the confusion typically arises when you get your dental bill. Another confusion is between a deductible and a co pay. These are two separate entities. A deductible is a one-time fee that you pay each year to your insurance company. It’s collected at your dentist’s office but it goes to the insurance company. You can think of it as an annual fee charged by the insurance company for processing your claims etc. A co pay is a payment you make to the dentist as a part of the payment for a particular treatment. A co pay will vary depending on what you had done. It varies according to the percentage your insurance will pay for that treatment. Say if your insurance pays 60% for root canals your co pay will be 40% of the amount you need to pay for the root canal. A dentist participating in an insurance plan is bound by his contract with the insurance company to collect any co pays that they state he or she should collect. At Rane’s Exclusively Yours Dental, our treatment coordinators make sure that these things are discussed with you before we do any treatment so that nobody gets shocked with that dental bill. All treatments are presented to our patients by the dentist first and then again by our staff to explain how the billing will work for these procedures and we gladly answer any questions you may have. We participate in dental insurance plans like Aetna, Delta, Guardian, Cigna, Horizon Blue Cross Blue Shield, MetLife, United Healthcare, United Concordia and many others. We even offer various payment options and interest free financing for those that need it and an in house dental plan for the non insured. So before you receive another dental bill and have fumes coming out of your head come to Rane’s Exclusively Yours Dental where we turn your dental bill into bite size pieces!!!
Rane’s Exclusively Yours Dental is a state of the art dental practice serving adults, seniors and children in all aspects of dental care including fillings, crowns, bridges, LUMINEERS, dentures, implants, LUMIBRITE teeth whitening, INVISALIGN, one visit root canals, extractions, sedation dentistry and a lot more. Rane’s Dental Aesthetics is our specialty office providing Orthodontics and Periodontics.
Rane’s Exclusively Yours Dental (Main Office). Plainsboro Shopping Center (Beside Super Fresh and Dunkin Donuts). 10 Schalks Crossing Road, Plainsboro. 609-275-1777. www.ranesdental.com
Rane’s Dental Aesthetics (A Dental Specialty Extension for Orthodontics and Periodontics). New Plainsboro Village (Beside 1st Constitution Bank), 11 Schalks Crossing Road, Plainsboro. 609-750 1666.