Insurance

INSURANCE GUIDELINES

We provide services for our patient with the understanding that they are responsible for payment in accordance with our financial policy. Please know that we will do everything possible to see that you receive the full benefits of your insurance policy. Dental insurance is different than most medical insurance plans and it is important to be aware of the following:

• Insurance is an agreement between you and your insurance company: The insurance relationship constitutes an agreement between the insurance carrier, the employer and the patient. Our dental office is not a party to this contract. As such we can make no guarantee of estimated coverage or payment.
• All dental fees are not always covered: Insurance companies base the amounts they pay on restrictive fee schedules, regardless of what the actual fee may be.
• Some dental procedures may not be covered: Not all dental services that are necessary for excellent dental health are covered benefits in all contracts. This depends on the kind of plan your employer has purchased.

Here’s What we Promise to Do:

• Complete Insurance Claim forms and submit to your carrier within 24 hours of treatment
• Use current American Dental Association coding for correct reporting of procedure.
• If necessary, re-file your insurance a second time within a 30-60 day period

Your Responsibilities Will be to:

• Pay our fees at the time of treatment or as otherwise arranged in advance.
• Provide our office with necessary information concerning your insurance coverage to allow correct filling of claims.
• Understand that your plan is a contract between you, your employer and the the insurance carrier. Our office will do all we can to facilitate claims payment,
  but we do not have the power to force your insurance company to pay.
• Understand your insurance benefits and frequency limitations.

INSURANCE FAQS*:

Can I See a Dentist Without Dental Insurance?

• Is it possible to afford quality dental care if you or your family doesn’t have dental insurance? Absolutely. But to understand how, you must first understand what goes into the benefits that you might be missing should you drop your coverage.

Understanding What Dental Insurance Pays For

• Nearly all dental insurance plans are prevention-focused. They pay for preventative services like checkups and cleanings plus any necessary X-rays.When restorative procedures like fillings or crowns are needed, the insurance plans generally pay less for the service, and only after a specific dollar deductible has been paid by the patients. More involved or complex treatments are also covered, but the plans generally pay much less to the service provider than what the public would pay.
• When restorative procedures like fillings or crowns are needed, the insurance plans generally pay less for the service, and only after a specific dollar deductible has been paid by the patients. More involved or complex treatments are also covered, but the plans generally pay much less to the service provider than what the public would pay.
• In addition, most plans have a maximum allowable amount, that, once met, means your insurance won’t pay anything until the next calendar year. Additionally, elective services such as cosmetic procedures are not covered at all.
• In addition, most plans have a maximum allowable amount, that, once met, means your insurance won’t pay anything until the next calendar year. Additionally, elective services such as cosmetic procedures are not covered at all.

How Much Dental Insurance Really Covers

• Once you have done the math, the money that you pay into your dental insurance policy each year is about as much as what it would take to pay for your six-month preventative care appointments, plus a little more. If you have healthy teeth and practice proper oral hygiene, you probably have few dental problems, and it may actually be more cost effective to pay directly for dental care than it is to enroll in a dental insurance plan.
• Adding insult to injury, insurance allowable amounts often cap out at around $1,500.00 per year (with good plans capping out at around $5,000.00). This amount has not changed in nearly four decades. While medical insurance coverage has adjusted with the cost of inflation, dental policies have not. That means you’re getting the same coverage as a family did in the 1970s. Realistically, if you need extensive restorative or rehabilitative care insurance will not cover everything.
• Seeing a dentist without dental insurance is similar to fee-for-service dentistry, where the patient pays for their appointment and is then partially reimbursed at a later point directly by their insurance carrier.

How to Keep Dental Costs Down

• Most oral health concerns are preventable. By choosing to see your dentist every six months, you will be equipped with the tools and information that you need to lower your risk of tooth decay and gum disease. Additionally, your dentist can diagnose concerns at earlier stages.
• Treating areas of decay or infection earlier means less-invasive therapies that are more affordable. Such treatments are also healthier for your teeth, because less tooth structure or soft tissues are involved.

Elective

Dental insurance usually does not cover elective types of dental procedures such as cosmetic dentistry. Some common examples would include cosmetic veneers or teeth whitening.

As discussed below, there are exceptions to this rule. For example, some patients have a type of irregularity on a front tooth that needs to be repaired, but a dental crown would be too aggressive to the rest of the tooth structure. A veneer or cosmetic bonding would be less invasive and serve as a restorative-type procedure. If such a situation arises, we will submit our case notes, photographs, and X-rays your dental insurance company in an effort to convince them to pay for the treatment.

Some Restorative Treatments are Cosmetic Dentistry

Restorative dental treatments are almost always covered by your dental insurance. Restorations include things like fillings and crowns. It can also include dental implant therapy, depending on the specifics of your plan.

Restorations can be made in ways that are aesthetically pleasing and can therefore make up a crucial part of your smile makeover and still be covered by your insurance. When we use white composite fillings, or ceramic restorations to address physical damage to your teeth, you have a better chance of them being covered by your dental insurance.

A Combination of Treatments

Every smile makeover is unique. Dr. Roshan will evaluate your needs on a comprehensive and tooth-by-tooth basis. In some situations, a variety of restorative and elective treatments are used to achieve an overall goal. If you need to whiten your teeth before replacing a single porcelain crown (crowns can’t be whitened after they’re placed) you would have to pay for the whitening out of pocket, before filing the crown against your insurance benefits.

As part of your cosmetic dentistry plan, we will provide a variety of options and a detailed breakdown as to what is covered (or not) by your insurance benefit package.

In most cases, you can easily finance the portion of your treatment that isn’t covered by insurance, making it more affordable. If your insurance pays more than you expect, you’re left with a lower out-of-pocket amount.Please speak with our Financial Coordinator to find out which types of cosmetic restorative treatments are covered by your insurance.