Dental insurance isn't really insurance, it's a benefit plan that only about half of employers offer to employees and should be considered a coupon rather than insurance. Most dental benefit plans only cover up to $1500 per year and will not pay anything beyond that, whether a procedure is dentally necessary or not. This $1500 average annual maximum has not changed much in the past 40 years even though premiums are going up and dental benefits are becoming more restrictive in what they cover.
With most dental plans, we will contact your insurance plan for an estimate of how much they will pay for your care and collect just your portion at the time of service. Because we are only able to estimate coverage, there may be a difference once the claim has processed. If an additional amount is owed, you will receive an invoice requesting an additional payment. For certain insurance plans that we are not contracted with, we will collect payment in full at the time of service and your insurance will send the reimbursement directly to you.
We are in-network with Delta Dental Premier, Cigna PPO & Aetna PPO. With the exception of HMO plans and denti-cal, most plans allow patients to choose their own dentist. However, your insurance plan may reduce your coverage for seeing an out-of-network provider. We are happy to contact your insurance company to learn about your plan details. You are also welcome to contact your insurance provider at any time.
Many employers offer several policies to choose from. The best plans allow patients to select their own doctor and offer few restrictions with a high annual maximum.
Dental offices determine their fees based on averages within their area. They also must take into consideration using the best labs and highest quality materials. Some plans state that they pay 100% for preventive visits, including cleanings, however they only pay based on a fee that they determine as opposed to the average fees for that area. This results in the patient owing the difference. When selecting your plan, be sure to ask if the maximum contract allowance is comparable to the averages fees for dental care in your area.
Call us today to inquire about Dr. Nam’s Healthy Smiles Discount Program. We want to encourage those without insurance to maintain their health through preventative care and regular cleanings.
Covered California is now offering adult dental benefits through family dental plans. Please visit Covered CA - Dental Coverage for more information.
Some employers offer Flex Spending Accounts (FSA), Health Savings Accounts (HSA) or direct reimbursement for dental care. If you are self-employed or do not receive any type of benefits, consider a medical plan that allows for an HSA option. Contributions are tax deductible and withdrawals are not penalized when used for qualifying medical or dental care. For more information visit the US Department of Treasury.
If you are looking into an individual dental insurance plan, be wary of the vast restrictions. We have seen that individuals often pay more in annual premiums than they will actually receive in benefits and services. At times, cases such as crowns and bridges, are not covered for months due to waiting periods if they are covered at all.