It is vitally important that our patients understand the role that insurance has in their oral health. First, insurance should only be considered a benefit to assist in the cost of dental care and not universal coverage. It is simply a contract between the insurance company and the employer that determines what benefit can be paid towards dental treatment. There are literally thousands of different plans, and while we can often inquire on your behalf, it is ultimately your responsibility to know the terms of the contract – your benefits coordinator would be the ideal person to contact if you are unsure of the details.

We want to make it very clear that insurance companies are in business for profit. They say and do many things to interfere with the relationship between the patient and the dentist. They do not look out for our patient’s best interest, and they often attempt to interfere with our ability to provide high quality dental treatment.

One very common example is, “The patient is eligible for 9 month recall.” In this case the insurance company makes it seem like you are only eligible for cleanings every nine months. In almost all cases, this nine month interval only applies to the check up with the dentist. There are usually provisions that will pay for additional cleaning visits in between check ups, as nine months is too long a period for almost all adults to maintain their periodontal/gum health.

There are limitations in all benefit plans for what the employer will cover from annual maximums, to limited coverage on ‘major’ procedures, to providing coverage for only the least expensive alternative for treatment. Again, when a patient receives notices from the insurance company, it is often confusing, and the patient can be led to believe that if a procedure is not covered, then it might be unnecessary. Nothing could be further from the truth, and by rejecting proposed dental treatment, it lines the pockets of the insurance company, and provides obstacles to you receiving the quality of care that you deserve.

In our practice, the patient is always in control of deciding which treatment they wish to receive. If you wish to have only dental care that is covered by your plan, it is your responsibility to make this very clear to us, and we will do our best to stay within the confines of your benefits. However, it is our responsibility to let you know that in many cases, by limiting the level and amount of care that you are receiving, that the outcome of treatment often becomes less predictable.