If you were to take a survey of people who work in dental offices and ask them, “What is the most common question asked when someone calls your office for the first time,” it’s not going to have anything to do with the doctor’s clinical skills, or if their office uses high-tech equipment. It’s likely not about the amenities provided such as coffee, snacks, blankets, or headphones. The hours probably don’t come up or even the location. No, the most common first question is, “Do you take my dental insurance?”
I get it. If I’m paying for something, I want to make sure I’m using it. I think it’s a good question to ask. The problem with that question is two-fold though, and this article will explain why the question is problematic and equip you with a better way to ask your question so you get the information you need.
1. The answer to “Do you take my dental insurance,” is probably always “Yes,” even when the dentist is not contracted with your carrier.
Let’s say you’ve called a dentist who is “fee for service”. This means they are not contracted with any dental plans. In other words, they will be “out of network” with your dental insurance. Even if they don’t take ANY plans, chances are they are still filing claims for their patients. This is an expected standard of service in 2019 and you will receive reimbursement from your dental insurance provider.
If your plan is a “PPO” it is a “Preferred Provider Organization” and you can see any dentist that YOU, the consumer, prefers and the dental plan will pay. Even a dentist not contracted with any insurance plans, will take your insurance. But if they do not have a contract with your plan, you will pay the dentist’s regular fees, which are almost always higher than the “in network” contracted fees.
Don’t immediately reject this option though! Sometimes the doctor that isn’t contracted with your dental plan is the best dentist in town. Maybe all your friends recommended him and he has a hundred five star reviews. Maybe he is the only dentist close by who does a procedure that you want or maybe she’s a specialist that your general dentist wants you to see for a problem that is out of his scope of care. There are lots of reasons to see an out-of-network provider and the good news is, as long as you have a PPO, you can see any doctor YOU prefer and your dental insurance will still reimburse you. You will have to pay more out of pocket, but for some people, that is well worth going to the dentist of their choice. If finances are the biggest consideration though, it is probably best to make sure you ask the question the right way. Rather than saying, “Do you take my dental insurance,” the better question would be, “Are you contracted as an in-network provider for my dental insurance?”
2. Dental insurance isn’t really “insurance” at all.
This is probably the biggest misnomer for consumers and I’ve tried to educate as many of my patients as I can to the truth of what they have purchased. Generally speaking, medical insurance is something that the more you use, the more the plan will pay. Once you’ve reached your medical deductible, you only have to pay the co-pay. After a certain amount of out of pocket expenses, sometimes you won’t have to pay anything else.
Dental insurance works opposite of this and it’s why, when I’m working in a dental office, I don’t even call it dental insurance. I call it dental benefits. In a nutshell, this is what you typically get with dental benefits:
- Two cleanings a year, plus your routine exams and x-rays, at your general dentist’s office.
- A discount on everything else, up to whatever limited amount your plan covers, at your general dentist’s office.
That’s it. With medical insurance, oftentimes if you have to pay a lot in the beginning, you won’t have to pay anything in the end. With dental benefits, the more they pay out, the less you have. For healthy people, without oral health problems, this isn’t usually an issue. If you are paying for dental benefits, I recommend you find a dentist who is in-network with your plan. Once you have found a dental home be sure to take advantage of your two cleanings each year. I cannot stress this enough! If you are going to pay for dental benefits and you do not go see your general dentist for your routine exams and cleanings, you are wasting your money! Stop paying and just save your money for the work you will inevitably need. With dental benefits, regular check-ups, and cleanings, even if you end up getting a cavity or needing a crown your premiums will pay for themselves and it will be a good deal for you.
But if you find yourself needing more extensive dental work, you will need to get out of the mindset that you have “insurance”. You do not, especially if you have to see a dental specialist such as a periodontist, endodontist, or oral surgeon. You have a dental benefit that will give you a small reimbursement for some of the work and then cap out, usually sooner than you expect.
This can be disappointing and frustrating for consumers if they are unprepared and taken by surprise. However, when you understand how it works, you will know the right questions to ask and trust between you and your new dentist won’t be eroded by an unexpected expense. Not every dental front desk person has the training or skills to effectively explain these concepts so the more educated you can become about your own plan, the less unnecessary frustration you will feel.
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