How Dental Insurance Really Works
Most dental insurance or dental plans are a contract between your employer and insurance/benefit provider. As a result of this arrangement, your benefits are a direct result of how much money your employer pays into your plan. There tends to be a lot of confusion about how dental benefits function— especially when we use medical insurance as the baseline for comparison.
Medical insurance is designed to protect you against catastrophic loss. Dental insurance was designed at the onset of the 1960s as more as stipend to allow for preventative care and maintenance. Although lawmakers are currently pushing for legislation to require dental insurance carriers to treat dental coverage more like traditional medical, dental coverage has remained largely unchanged since its inception.
A recent report that aired on WHYY-FM does an excellent job of explaining the ins and outs of the limitations and history of dental insurance as it compares to medical insurance. One major issue explored is called LEAT (Least Expensive Alternative Treatment). LEAT requires that dentists who have contracted with dental insurers to treat a patient with a less expensive procedure even though it may not be the best option when taking into account patient desires, expectations and even oral health. In this case the insurers dictate your level of care… not the dental professional.
When patients opt to pay for dental care outright, dental practices are not influenced by the treatment fee schedule incentives set by insurance companies. This freedom tends to bring a better level of care— with more time spent on your case and a higher level of patient satisfaction.
The majority of dental plans are capped at $1000 to $2000 per year. This comes along with insurer-set rules and stipulations that can limit your dentist’s ability to provide the care that’s best for you. For example, factoring in routine/preventative care, exams and X-rays for the year— there’s very little left over should you need procedures like root canals, crowns and anything beyond a filling or two. The patient becomes responsible for the rest of the payment. It’s frequently the case that if you are in need of anything beyond the basics— there simply won’t be enough coverage to maintain your oral health via a dental plan.
Knowing Your Coverage
Bash Dental is a non-participating or out-of-network provider. We can submit claims for most dental insurance/plans that allow you to choose your own dentist (PPOs). However, we are unable to submit claims for state-funded insurance and HMOs.
Payment & Reimbursement
You are responsible for payment at the time of your visit unless other arrangements are made in advance. Our office will submit claims on your behalf— and your dental insurance carrier will send reimbursements directly to you. For your convenience, we accept all major credit cards, personal checks and cash.
Because of the many insurers and the unique nature of various dental plans, you will need to contact your employer or insurance carrier directly to know your specific coverage details and reimbursement rates. Make sure to ask for your EOB (Explanation of Benefits).
It should be noted that many of our patients do not opt to purchase dental insurance and instead pay outright for services. Arrangements can be made to make quality care affordable for all. Make an appointment for a consultation to see how Bash Dental can restore your smile at a price that works for you and your family.
If you have any questions regarding insurance and payment, we’re always available to help you! So don’t hesitate to contact our Doylestown office at 215-789-4106. Thank you for choosing Bash Dental!