Dental insurance is a highly complex area that creates confusion for many dental patients. The complexities of dental insurance and the lack of sufficient information provided by some insurance companies make it almost impossible for some patients to properly understand their benefits. Even more confusing is the understanding how to properly work with your dental insurance company to achieve the highest level of benefits to which you are entitled.
Dental insurance is a contract between your employer and a dental insurance company. The benefits that you will receive are based on the terms of the contract that were negotiated between your employer and the dental insurance company and not your dental office. The goal of most dental insurance policies is to provide only basic care for specific dental services. The services selected are based on the cost of the policy to your employer and the negotiated arrangements with the dental insurance company.
Because the benefits you currently have are decided between your employer and the insurance company, many services are not covered. The selection of non-covered services is not based on what you need or want, but is based strictly on the contract with the insurance company.
Not all dental procedures are a covered benefit. Coverage varies from one insurance company to another, and it is all based on the contract agreement with your employer. Coverage dwindles down to how many frequencies you are allowed, as well as how much you are allowed per year. Each year (whether calendar or fiscal) coverage is capped at a maximum allowed benefit. Once the maximum is reached, treatment will not be covered, no matter how much it is needed.
Your benefits are dictated by your employer and the insurance company, such as: the number of exams you are allowed per year; the maximum dollar amount your insurance will pay per year; and the procedures that are covered or not covered.
Our office will explain to you what the benefits that are provided to you by your insurance company. We will submit dental claims to your insurance company in a timely fashion to achieve the maximum reimbursements to which you are entitled to. We will work diligently to ensure correct payment is received. Some dental insurance companies pay claims less than 30 days, others take longer. If necessary, our office will contact your insurance company, or we may request your help in this matter.
Our office remains dedicated to providing you superior customer service. Whether you have questions regarding your insurance or coverage, we want to help. Please contact if you have any questions regarding your dental insurance.
Dear Dr. Basta,
Just wanted to thank you once again for doing such a great job on my implant which was way overdue anyway. I wished I did it sooner, but then again, I'm glad I was referred to you.
Rancho Cucamonga, CA