We take care of our patients based on their treatment needs and not based on the limitations of dental insurance. There is a great deal of confusion about dental insurance. To be clear, we do not work for any insurance company or for any PPO or HMO. We work for you. Our treatment recommendations are based solely on what will give you the best outcome in consideration of your treatment goals and preferences. In general, a dental insurance company will base treatment allowances based on what is best for their profit margins. With this in mind, we are a fee for service office. This means that we do not let an insurance company dictate when, where, or how to treat a patient. Fees for our services are the responsibility of the patient. However, we will do everything possible to maximize your insurance benefits including filing to your dental and medical insurance carriers. Their reimbursement to you is based on your plan that has been negotiated between your employer and the insurance company.
There are two methods commonly used by dental insurance companies to limit your reimbursement. The first is the payment schedule, which limits the amount covered for any particular procedure. Payment schedules are specific to the carrier, plan details, and employer selection of your plan. The second, and most restricting, limitation to benefits is the yearly maximum payment the dental insurance company will reimburse. Regardless of the procedure coverage, most dental insurance companies will cap payment between $1000 and $2000 per calendar year. Therefore, if the insurance company’s scheduled reimbursement for a $3000 procedure was $2400, they would still only pay up to their yearly maximum of $2000. While we are not directly involved with any insurance company, we will do all we can to help you derive the maximum benefit from your insurance plan.