The Truth About Dental Insurance

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The Truth About Dental Insurance

Image of a tooth and the word dental insurance

At Mission Laser Dentistry in Orange County, we care committed to providing excellent care for our patients while helping them maximize their dental benefits.  Sometimes these two objectives can be at odds with one another though.  Dr. Robert Faber and his team have discovered that dental patients often have misconceptions about what dental “Insurance” really is and how it works for them.  In this blog I hope to give you a better understanding of some of these misconceptions while also explaining how MetLife, Aetna, Delta Dental and others really work for the people that pay their premiums.

You must understand that dental “Insurance” is not really insurance at all.  At Mission Laser Dentistry, we tell our patients that what Delta Dental, MetLife, etc. are offering are actually better termed “Dental Benefits”.  The reason we use the term Dental Benefits is many fold, but some main reasons are:

(1) Maximum Annual Dental Benefits

A typical Dental Benefit Plan has an Annual Benefit Maximum of usually $1500 or less.  This means that someone may have a large amount of dental disease (or a situation in which they have broken several teeth in an accident) but their “Insurance” (really just their benefits!) stop paying for their treatment when $1500 has been remitted to the treating dentist.  The patient is responsible for the amount of treatment fees that exceed $1500. Unlike Medical and Auto insurance, there is no provision in dental benefit plans to provide for care beyond the plan’s annual benefit maximum should the patient’s treatment needs exceed this amount.

(2) Not Every Dental Procedure is Covered

Dental Benefit Plans define what services will be paid for irrespective of what is in the patients best interest or what the patient’s “wants” are.  In other words, many services that a patient would like-such as white fillings, porcelain crowns, porcelain veneers and teeth whitening treatments are often excluded from a given benefit plan.  It really just depends on what the individual/patients employer has  (agreed to pay for) provided for them

(3) Deductible Paid Upon First Billing

In terms of Dental Benefit Plans, your deductible is paid upon the first billing that is submitted in a given year-  It is usually $50 or so.  This is quite unlike Medical and Auto Insurance where your deductible must be satisfied (paid up to) before the Insurance starts paying.  Once Medical and Auto deductibles have been paid, generally the individual has no more costs associated with the claim/incident/treatment.

(4) Co-Payments Continue After the Deductible Is Fulfilled

Unlike Medical Insurance, after an individual has paid their deductible for a given year, thereafter the patient still pays co-payments for most dental procedures that are rendered.  For example a co-payment for a crown or a filling is typically 50% of the dentists fee.  That is, the Dental Benefit is 50% and the patient is responsible for the other 50%(co-payment) of the fee.

At Mission Laser Dentistry we are happy to help patients Maximize their Dental Benefits and we do have contracts with most of the major benefit providers.  Dr. Faber’s PPO (preferred provider) fees with these benefit providers can save you considerable money on treatment fees.  We are happy to discuss how your particular dental benefit plan can work toward getting you the care you need and also how Dr. Faber can provide you the care you want!

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