Dental Insurance

Dental Insurance.

One of the most confusing areas of dental care is dental insurance. At iSmile we are experts at helping you get the most out of your insurance coverage. We accept all of the major dental insurances including: Aetna, Altus, Assurant, Blue Cross Blue Shield, Cigna, Delta Dental, Guardian, MetLife, Principal, and more. Some we accept as a network provider and the rest we accept as an out of network provider.

In most situations it is to YOUR advantage to go out of network! (see network vs. out of network)

More and more people today have some form of dental insurance. Many people expect their dental insurance to work in much the same way as their medical insurance. With most medical insurance if you are in need of care, for the most part your medical insurance will cover it. Unfortunately dental insurance works much differently.

However regardless of which practice you choose there are certain limitations to dental insurance. Dental insurance puts a yearly limit on how much will be covered regardless of your dental needs. (Between $1,000 and $1,500 per year) In fairness to the dental insurance companies the premiums are also typically much lower for dental insurance than medical insurance and it is not possible for them to provide equivilant coverage to traditional medical insurance.

When dental insurance was introduced in the late 1960’s. Bread cost 21 cents a loaf and limits on dental insurance were $1,000 per year. It was not ideal but it filled the needs of many patients. It is now almost 40 years later, the cost of a loaf of bread is around $2.50, more than 12 times as much. Yet most dental insurances still only cover between $1,000 and $1,500! It is just not possible for many people to get the care they need solely from dental insurance. In order to keep up with the inflation since 1960 your insurance would need to cover over $12,000 just to give you the same level of care you would have gotten 40 years ago!

People are Different

To complicate matters the need for dental care can vary dramatically from one individual to another. Genetics, home care, preventative care, diet, and age are just a few of the factors that influence annual dental costs. A twenty-two-year-old healthy adult with excellent home care may be able to maintain their oral health on the $1,000 per year that dental insurance benefits provide. On the other hand it is possible an older person with different circumstances could be in need of thousands of dollars in treatment. Unfortunately, dental insurance in its current form does not adequately meet the needs of these people. At iSmile we realize everyone has different financial situations and different priorities for their oral health. Sometimes people will tell us that they “only want to do what insurance covers”. This is of course their choice but we hope this explains why that choice does not often result in them getting the care they may need.

Which Insurances Do We Accept and Why?

At iSmile Dental Associates we are participating providers of Delta Dental and Blue Cross Blue shield. We also accept all dental insurances that allow their participants to choose dentists outside of their network. Some of these plans include Aetna, Altus, Assurant, Cigna, Guardian, MetLife, Principal, to name some of them. Any of our business staff can answer specific questions regarding your insurance.

In Network vs. Out of Network and How it Affects You!

When a dental office participates as a network provider for dental insurance they agree to accept the fees that plan dictates. This means if the insurance company for example tells the office they can charge $1,000 for a crown (a permanent restoration of damaged tooth), the insurance company may pay $600 and the patient would pay $400 but the total cannot exceed the fee the insurance company set at $1,000.

The problem is that in an effort to attract members to their plan some insurance companies set fees well below what is necessary in order for the dental office to provide quality care. For example: There are two primary costs associated with dentistry. The cost of materials and the time spent by the dentist and the office.

The laboratory fee that the office pays a laboratory for making a crown (a common procedure) can range from as little as $100 to as much as $700 or more depending upon the quality of the laboratory making the crown. This quality affects things like color, strength, and how well the crown fits. The other factor dictated by the fee charged is how much time the dentist is able to commit to the procedure.

Some insurance companies allow as little as $600 total for a crown procedure. This does not allow enough for the office to use a high quality laboratory and it makes it difficult for the dentist allocate sufficient time to perform the procedure in a quality manner. The result can be poor color, materials, and a poor fit which can allow decay under the crown and result in premature failure.

Going out of network is typically to your advantage!

At iSmile we have chosen to participate in plans that allow us to give you the best possible care. With other plans we have chosen NOT to participate for the same reason! By not participating we are able to charge fees allowing us to provide better dentistry. Your insurance company will still pay a portion (often more than they would in network) and you are responsible for the balance. It is true that you may pay slightly more than you would if you went to a network provider. However, by doing it this way we can use the best materials and allocate enough time to give you the best possible quality. Our patients tell us that the advantages far outweigh the slight difference in cost. We believe that you and your dentist should determine your dental care not your insurance company.

At Ismile we are experts at helping you get the most out of your insurance benefits. In addition we can often find other ways to make your treatment affordable. One option we provide is dental financing from Capital One Healthcare Finance. In addition we can often find ways to schedule your treatment to make it more affordable. We are very pleased you have chosen Ismile dental associates to be your dental health provider. Please let us know if there is any way we can make your experience better.