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Should Your Dental Office Refund What Your Dental Insurance Does Not Cover?

Dental Insurance

Should Your Dental Office Refund What Your Dental Insurance Does Not Cover?

This dental insurance answer may vary between dental offices.  Dental insurance is a nice benefit but is not intended to cover all of your dental expenses.  For the last 25 years, our office has been trying to help our patients maximize their insurance.  However, the insurance contract is between the patient and their dental insurance company.  The patient is financially responsible for payment of all amounts that are not paid by insurance.  In our office we try our best to work with patients to make dental care affordable.

Do not compromise your dental care by letting the insurance company decide what is best for you!

 

Our office will make every effort to estimate your costs precisely but your dental insurance may pay more or less than estimated.  Your insurance estimate may be reduced if your annual maximum is reached due to treatment in another office!

I would like to share an experience regarding dental insurance and I would love to hear your thoughts regarding how we handled this!  Our patient is asking our office to write off his balance because insurance did not pay as much as he thought for his daughter’s fillings.  We will not do this for the following reasons:

  1.  Our patient chose to have his daughter’s wisdom teeth extracted prior to completing her  restorations (fillings!) using up most of his daughter’s remaining dental insurance benefits.  We cannot be responsible for his decision to proceed with treatment in another office, and we do not know what benefits were used for this or any other dental treatment outside of our office – the patient has to be responsible for this.
  2. We reviewed prior to any dental treatment that insurance will pay up to a maximum yearly benefit in any dental office, and he understood this as evidenced by his wanting to spread dental treatment over a couple years.
  3. If his daughter’s fillings had been completed prior to the wisdom tooth extractions, there would have been insurance benefits for the fillings, and the wisdom extractions would not have been covered.  Yet she received excellent care in both offices!
  4. If we (or another dental office) had not completed any restorations for six months or more to wait for new insurance benefits, his daughter would most likely need root canal restorations and/or crowns to save her teeth. Just one root canal and crown can cost over $3,000.00!  If covered at 50%, a single root canal and crown can easily use up one year’s benefits on the patient’s current insurance plan.  So, in effect, having the restorations completed as soon as possible may have saved a significant amount of money.
  5. Dental insurance is a very limited benefit plan and his daughter’s extensive decay and the extractions would have used up most of three years of dental insurance benefits! That is a long time to let decay progress!

We enjoyed seeing the patient and his daughter and noted improvement in her oral hygiene!  We feel teeth are important and taking care of teeth in a timely fashion can be cost effective. We hope that the additional areas of decay are treated soon.   Dental insurance can be very confusing and having treatment in multiple offices adds to the confusion. We would be happy to come up with a payment plan or look into financing for dental treatment to allow the remaining balance to be resolved as comfortably as possible.  Along with other financial options, we do offer six-month  interest free loans with Care Credit to help make dental treatment more affordable and to help patients  get their needed dental treatment done in a timely fashion.

As a patient I would recommend that you read your dental insurance policy thoroughly.  Ask your dental office insurance questions.  Call your dental insurance company for clarification on how dental insurance payments will be handled and and your maximum yearly benefit concerns!  Take control of your dental insurance to maximize your benefits but I hope that you do not compromise your dental care by letting the insurance company decide what is best for you and when you should have treatment.

That is just not smart!

Yours for better dental health,

Julie Gillis DDS

Restoring Smiles/Restoring Health