As an optimum care dental practice, we strongly believe our patients
deserve the best possible services we can provide. In an effort to maintain a
high quality of care, we would like to share some facts abut dental insurance
FACT #1: Your dental insurance is based upon a contract made between
your employer and an insurance company. Should questions arise regarding your
dental insurance benefits, it is best for you to contact your employer or
insurance company directly.
FACT #2: Dental insurance benefits differ greatly from general
health insurance benefits. In 1971, your dental insurance benefits were
approximately $1000 per year. Some 35 years later, you will note that your
benefits are still $1000 per year. Figuring a 6% rate of inflation per year,
you should be receiving over $5000 per year in dental benefits. Your premiums
have increased, but your benefits have not. Therefore, dental insurance is
never a pay-all; it is only an aid.
FACT #3: You may receive notification from your insurance company
stating that dental fees are "higher than usual and customary". An
insurance company surveys a geographic area, calculates an average fee, takes
80% of that fee and considers it customary. Included in this survey are
discount dental clinics and managed care facilities which bring down the
average. Any doctor in a high quality private practice will have fees that
insurance companies define as higher than "usual and customary".
FACT #4: Many plans tell their participants that they will be
covered "up to 80% or up to 100%" but do not clearly specify plan
schedule allowance, annual maximum or limitations. It is more realistic to
expect dental insurance to cover 35% to 65% of major services. Remember, the
amount a plan pays is determined by how much the employer paid for the plan.
You get back only what your employer put in, less the profits of the insurance
FACT #5: Many routine dental services are NOT covered by insurance