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Important Facts Regarding Dental Insurance

These days, over 33 million people have insurance plans. Since dental insurance is a major benefit in many large companies, it is playing a more central role how people receive dental treatment.

We strongly feel that our patients deserve the best possible dental care, regardless of their insurance benefits. In an effort to maintain this high quality care, we would like to share some facts with you about dental insurance and how it works.

FACT #1

Dental insurance is meant to help you pay for your dental care. Although many of our patients believe their plan will pay up to 80%, even 100% of their dental fees, our research indicates that most plans cover only 40% to 50% of an average fee.

If you get your insurance from your employer, what your plan covers is determined by the insurance company and how much your employer paid for the plan. All insurance companies are different, so some plans may pay more for a particular procedure while others pay less. The best way to know what your insurance company covers is to read your insurance policy.

FACT #2

Sometimes, insurance companies tell their clients that certain dental fees are "above the usual and customary" or UCR, rather than tell them that the insurance benefits are too low.

We know that most insurance companies do not upgrade fee schedules, even with the cost of living index. Dental insurance in the 1960's paid out an average of $1,000 of dental benefits per year. Today, more than 40 years later, the average is still $1,000.

Again, the best way to know what fees are covered is to review your insurance policy.

FACT #3

Many routine and recommended dental services are not covered by insurance carriers. In fact, some preventive procedures are not covered at all. There are a number of clauses insurance companies use, such as pre-existing conditions and alternate benefits, to restrict payment. That’s why we recommend that you read your insurance policy so that you are fully aware of any limitations.

As your dental professionals, we are happy to help you sort through any confusing issues related to your dental insurance. We will also fill out the forms and submit the claims as a service to you. You can ask us about our fees and policies during your visit or call us during office hours at 212-255-5330 or 718-375-8933.

We submit your claim to your insurance company after each visit. You are responsible for the total fee. This includes amounts not covered by your insurance.