The Real Truth About Dental Insurance

Dental insurance falls into two main categories – regular (or non-provider) and provider. The provider type requires you go to a dentist who is signed up with the insurance company and agrees to accept their own fees. In other words, they have their own fee schedule and tell a dentist what they can charge. Some provider companies will pay a lesser amount if you go to a non-participating dentist. We accept any insurance that does not require you to go to a participating provider dentist and those provider companies that are willing to pay anything toward a provider patient’s dental charges.

Who is a provider and why are the majority of dentists (including me) not on a provider list? A provider is a dentist who participates with the insurance company and agrees to charge fees provided by the insurance company. The insurance company calls these fees “usual and customary”. The problem is that they are anything but “usual and customary” for the area. Since many of the fees are extremely low it requires the provider dentist to see more patients for shorter appointments. Basically, it is an attempt to gain more participants for their programs. They do this by making patients believe that regular dentists overcharge patients and that all provider dental services are equal to those of regular dentists. Nothing could be further from the truth.

Also, you must know that insurance companies will not give their fee schedule to dentists so we can more accurately provide information to patients who choose to come to us. Our computer information is based on what little information the insurance company will give us and information we have from other patients with the same insurance. Provider companies will say that they pay a certain percentage of their fee schedule or “usual and customary” fees. So what is that and how can we figure that? We only know for sure after the dentistry is done and we submit a claim. That claim may or may not be paid to the patient’s satisfaction.

Any dental insurance is a contract between you (the patient) and the insurance carrier – not between the insurance carrier and us (the dentist). Our computer is not linked to any insurance company’s computer. Our information about your insurance is an estimate.

Hopefully, you now have a better understanding about dental insurance programs. We will do our best to find out what your benefits are but your dental bill is ultimately your responsibility whether your insurance pays or not.