ABOUT DENTAL INSURANCE

How insurance works

One of the most confusing areas of dental care is dental insurance.  At Amerident Dental Associates we are experienced in helping you get the most benefit from your insurance coverage.  We accept all major dental insurances including:

• Aetna
• Assurant
• Cigna
• Delta Dental
• Guardian
• MetLife
• Principal, and more

We work with Delta Dental as a network provider and the others we work with as an out of network provider.  In most situations it is to YOUR advantage to go out of network.  (See network vs. out-of-network below)

More and more people today have some form of dental insurance. Many people expect their dental insurance to work in much the same way as their medical insurance. If you are in need of medical treatment, your medical insurance will cover a large part of it. Dental insurance works much differently.

No matter which dental practice you choose there are certain limitations to dental insurance. Dental insurance puts a yearly limit on how much will be covered regardless of your dental needs, usually between $1,000 and $1,500 per year.  (In fairness to dental insurance companies, premiums are also typically much lower for dental insurance than medical insurance so it is not possible for them to provide equivalent coverage.)

When dental insurance was introduced in the late 1960’s bread cost 21 cents a loaf and limits on dental insurance were $1,000 per year. It was not ideal but it met the needs of many patients. Now, over forty years later, the cost of bread is around $2.50, more than 12 times as much. Yet most dental insurances still cover between $1,000 and $1,500.  It is just not possible for many people to get the dental care they need solely from insurance. If dental insurance benefits kept up with inflation since 1960 your insurance would need to cover over $12,000 just to give you the same level of care you would have received forty years ago.

People are Different

The need for dental care can vary dramatically from one person to another.  Genetics, home care, preventive care, diet, and age are just a few factors that influence annual dental costs.  A twenty-two-year-old healthy adult with excellent home care may be able to maintain his or her good oral health on the $1,000 per year that dental insurance benefits provide.  On the other hand, an older person with different circumstances could have many areas of decay, infection or broken teeth.  Dental insurance in its current form does not adequately meet the needs of these people.

Which Insurances Do We Accept and Why?

At Amerident we are participating providers of Delta Dental.  We also accept most dental insurances that allow their participants to choose dentists outside of their network. Some of these plans include Aetna, Altus, Assurant, Blue Cross Blue Shield, Cigna, Guardian, MetLife, and Principal, to name some of them.  Any of our business staff can answer specific questions regarding your insurance.

In-Network vs. Out-of-Network and How it Affects You

When a dental office participates as a network provider for dental insurance they agree to accept the fees that plan dictates.  This means if the insurance company, for example, tells the office they can charge $1,000 for a crown (a permanent restoration of damaged tooth), the insurance company may pay $600 and the patient would pay $400 but the total charged cannot exceed the fee the insurance company set at $1,000.

The problem is that in an effort to attract members to their plan some insurance companies set fees (sometimes called “UCR”) well below what is necessary for the dental office to provide quality care.  For example, there are two primary costs associated with dentistry - the cost of materials, and the time spent by the dentist and the office.

The laboratory fee that the office pays to a laboratory for making a crown (a common procedure) can range from as little as $100 to as much as $700 or more depending upon the quality of the laboratory making the crown.  This quality affects things like color, strength, and how well the crown fits.  The other factor dictated by the fee charged is how much time the dentist is able to commit to the procedure.

Some insurance companies allow as little as $600 total for a crown procedure.  This does not allow enough for the office to use a quality laboratory and it makes it difficult for the dentist to allocate sufficient time to perform the procedure in a quality manner.  The result can be poor color, materials, and a poor fit which can allow decay under the crown and result in premature failure.  Going out of network is typically to your advantage!

At Amerident we have chosen to participate in plans that allow us to give you the best possible care.  By not participating with others we are able to charge fees that allow us to provide better dentistry.  Your insurance company will still pay a portion (often more than they would in-network) and you are responsible for the balance.  It is true that you may pay slightly more than you would if you went to a network provider, however, by doing it this way we can use the best materials and allocate enough time to give you the best possible quality.  Our patients tell us that the advantages far outweigh the slight difference in cost.  We believe that you and your dentist should make choices for your dental care - not your insurance company.

How We Can Help 

At Amerident we’ll help you maximize your insurance benefits.  In addition, you may find that other options we offer will make your treatment affordable.  Two payment options we provide are dental financing from CareCredit and Capital One Healthcare Finance.  In addition, we can often find ways to schedule your treatment over time so that it fits your monthly budget.  Please contact us for more information.

We are very pleased you have chosen Amerident to be your dental health provider. Please let us know if there is any way we can make your experience better.