Dental insurance is a misnomer since most merely provide a discount to our fees and only pay $1500 towards dental work.
Imagine if. . .
You have a lawn mowing business, and you agree to mow and trim Mr Jones’s yard for $50, but the HOA has a rule that you can’t charge for trimming, and work done on any Tuesday-Thursday is worth 50%. Your $50 job, which was excellent, by the way, only got you paid $20. Welcome to the crazy world of dental plans.
How do Dental Plans Work?
Our office has a normal list of fees we charge, and when we contract with your dental plan we accept their lower discounted fees. Yay you! Additionally, they can also act as a third party payor which means they will pay us, on your behalf, after the work is submitted. Sadly, we’ve learned that submitting to insurance is not a guarantee of payment even though we completed the work. Just like your lawn mowing business and the HOA we experience all kinds of loopholes, delays, and guideline restrictions that end up nickle and diming us. Delays due to “lost in the mail”, “failure to arrive”, endless requests for notes, narrations, x-rays, fotos, etc. and other delaying tactics make it a challenge to get paid for work performed. Denial of service is a favorite- despite performing services recognized by the ADA, and accepted by you, the patient,- dental plans are notorious for deciding what they will and won’t pay for making for a russian roulette approach to getting paid. Most plans are limited to $1500 a year after which you become responsible, which can be a surprise if you aren’t keeping track of what they’ve paid. We work very hard to understand your individual plan so that we can minimize surprises, but while we work with hundreds of plans, you will be well rewarded as you pay attention to your own plan. In the end we accept most plans because many in our community have some sort of plan they wish to use.
How Do Dental Plans Really Work?
In the past they helped encourage patients to engage in their dental health by incentivizing the patient to accept treatment. But, over the years, the plans have changed and now often discourage patients from engaging in great treatment because their plan only pays for mediocre options.
Big businesses and big government plans are the most generous and helpful plans. If you work for a small company or for yourself, dental plans are too expensive for what they deliver. If you were at the grocery store and realized that all 4 people in front of you had the same loaf of bread, but for each person the register rang up a different price, you’d see the conflict that dental plans create in our office. Our doctors deliver the same care and professionalism to each patient and case, but dental plans pay dramatically different for the exact same procedure.
Some plans lower our standard fee so low and or delay payment so often that we can’t afford to accept them. We accept plans because we see them for what they are, another wallet on the table to help you get what you want, we strongly encourage our patients to prevent the plan from dictating what they need, but let it help them get closer to what they want.
How Can I Maximize My Dental Plan Benefits?
The secret to getting good results from your plan is to be familiar with it and all their rules. While we are good at maximizing dental benefits, our patients who call and work things over with their dental plan are by far the most knowledgeable and successful.
- Learn the limits of YOUR plan. You and your employer pay the premiums so get familiar with it, and work WITH your dental office to maximize those benefits.
- Call us. We accept and work with many plans.
- Call your plan provider and ask them what-if questions. “What if I use up all my benefits in the early part of the year?” “What if I need braces and choose Invisalign?” “What if I want my dentist to do a procedure you don’t pay for?”
- Take the name of the person you are speaking with and their employee number.
- Ask them how, and what documents are needed to get the best coverage for your needs.
- Remember their job is to make money from the money you and your employer gave them, so it’s in their best interest to minimize expenses- YOU are that expense.
- Pay attention to your plan benefits and payments. This is especially important if you see a specialist or change dental offices.
If you are frustrated with your dental plan benefits or have no access to a plan we have eliminated loopholes and delay tactics and just created our own. It is a simple plan that requires a yearly fee and provides comparable discounts. It must help because over a quarter of our patients use it. Click here to learn more about our in-house dental plan.