Dental Insurance Facts

These days a lot of patients are relying on their dental insurance to help them make decisions regarding dental treatment. In an effort to provide the highest quality of care and to make sure our patients are well informed, there are a few facts about dental insurance we would like to share with you.

Fact #1:
Your insurance company may send you an Explanation of Benefits saying that dental fees are higher than “Usual and Customary” or in your benefit package it may state they pay a percentage according to what is “Usual and Customary”. Most insurance companies take all of the dentists in a zip code (including dental clinics), get an average for each fee and then take 70 percent of that fee and consider it “Usual and Customary”. This is revised approximately every 5 years.

Fact#2:
We have found that some insurance companies claim that a dentist’s “fees are above the usual and customary fees” instead of “our benefits are low”.

Fact #3:
Most dental insurance plans have made little to no increase in the yearly maximum amount they will pay out on claims. Today the average dental insurance’s yearly maximum is $1,000-$1,500. In 1964 the average dental insurance’s yearly maximum was $750-$1,000.

Fact#4:
Dental insurance really cannot compare to Medical insurance due to the fact that it is a supplementary aid and added benefit to help with dental costs, and not meant to “pay all” costs.

Fact#5:
It is the dental insurance company’s primary objective to pay the
minimum amount for the least care and their maximum profit.

**We have found that the typical insurance plan pays 35-55 percent on major services (crowns, partials, bridges, endodontics, and dentures)
due to one or all of the following: Pre-established maximum allowance,
fee schedule allowance, annual maximum, limitation, and deductable.