Please see below regarding forms required prior to your first appointment, information about our practice, after-care instructions and informed consent.
An overview of Dental Benefits
Dental insurance differs greatly from medical insurance in many ways. Please take a few moments to read the brief explanation of dental benefits provided below. We hope this will help you in understanding how dental benefits may apply to your upcoming appointment and any associated fees.
Employers provide dental benefit plans to help defray the cost of dental care. Many use the term “dental insurance,” but this term is misleading; dental benefits have a significantly more limited scope when compared to medical insurance.
Medical benefits protect patients from catastrophic and unpredictable loss due to illness or accident. Medical insurers consider these potentially extremely high-priced scenarios when determining premiums and coverage. Medical policies usually require some cost-sharing through annual deductibles and co-payments, then provide coverage for the majority of costs incurred during the year after the deductible is met.
In contrast, the average dental care cost per-person per-year is well under $1,000, an amount that insurance companies do not consider “an insurable risk.” Therefore, dental benefit plans are designed to make available a finite amount of money (the “total maximum benefit”—which rarely exceeds $2,000 per year and is often significantly less) to help cover dental care. Once the benefit is used, the patient is responsible for all other dental costs.
Insurance companies reason that since most oral disease can be prevented by personal dental hygiene and regular cleanings, dental benefit plans are designed to encourage regular check-ups. This works well until further treatment is required and dental benefits can be exhausted very quickly.
Additionally, the average dental benefit amount has not increased significantly in 30 years!
Preauthorization or eligibility determination through dental plans does not guarantee payment by the plan; it is simply an estimate.
Dental benefit plans also may limit the frequency of coverage for certain services for a given year, including examinations, radiographs and root canal retreatments.
When you participates in a dental benefit plan, the “benefit” (payment for certain services) belongs to you. If we do not participate in the plan, we are not entitled to receive payment from the plan for services rendered unless you “assigns the benefit” to us. An Assignment of Benefits Form is a legal document signed by you that transfers the benefit to the dentist.
The dentist files the claim with the dental plan, along with the Assignment of Benefits Form and any required documentation. The dental plan will then pay the dentist for the services provided under the terms of the contract.
Along with the payment, the dentist will receive an “explanation of payment” from the dental plan describing 1) the dentist’s billed charge, 2) the amount of benefit paid under the plan and 3) the amount the patient may owe the dentist.
The patient will receive an “explanation of benefit” form from the plan with the same information, including the amount he/she owes the provider.
The provider then bills the patient for any remaining balance.
Please look through all the provided forms before your appointment.