A Word Regarding Insurance and Your Treatment

Dental insurance is a benefit that many of our patients have. It is important for you to understand your insurance, and the involvement of our practice. As stated in our financial policy, you are responsible for the fees incurred at the time of service. Our patients understand the need for good oral health, and assume responsibility regardless of the level of their insurance coverage. Bear in mind that insurance companies invest your premiums, earn interest, and attempt to limit payments of claims.

The involvement of our practice is to help you obtain coverage for your care. The first step is our preparation of a pre-treatment estimate claim, which details your specific treatment and associated fees. This form is sent to your insurance company by our practice along with other documentation (i.e. films or x-rays and special letters called narratives) which are prerequisites in determination of care benefits. The insurance company then usually returns to either you; or us, or both, an estimate of dental benefits (EOB) in 2 to 4 weeks. You will be notified after receiving the estimate by our office.

The estimate of benefits specifies exactly the amount of insurance coverage for your specific care. People often say, "…but my insurance covers 50- 80% of periodontal services." The question then becomes 50-80% of what amount? For example, let us say that our fee for a surgical graft procedure is $1000, but in your insurance company's opinion, the maximum fee should be $600. If your insurance company pays 50% for this procedure, then the total benefit would be $300. This will leave a balance of $700 to be paid by you at the time of our provided care. We are glad to accept the difference providing that your insurance company has presented this to us in writing via the Estimate of Benefits statement (EOB).

In watching today's news and reading headlines; one realizes that many Fortune 500 companies and corporate icons are no longer able to offer the same level of healthcare coverage offered to their employees decades ago. In some instances; we have even seen the insurance companies delay responses in hopes that the patient will opt not to have services performed so that the insurer will not have to pay a claim. Unfortunately, it is the patient who suffers in these scenarios.

As a brief historical perspective; in 1965, the average yearly maximum dental insurance coverage was between $1000 and $1500. This was reasonable coverage considering the average cost of a crown was $150, and the average cost of a filling (restoration) was $20. Today, the average yearly maximum dental insurance coverage is between $1000 and $2000 (the same as 40 years ago!), yet the average crown today is $1000, and the average filling is $150. Something to think about!

Our practice is small yet personable, and committed to providing you the best care possible.

Tasha Edwards, BA Psych.

Camille Gray, BA Soc.

A. Todd McClain, DDS, MS