Here at the Smile Design Centre we’ve chosen not to contract with any dental insurance companies which sometimes means you pay more out of pocket. We want you to understand the why and how behind our decision and to thank you for valuing our service. You’ve likely noticed that we take a unique approach to dental care, and we love doing so! Here are some basic principles about dental insurance that may help you better understand your plan. As always, we’ll help you get the maximum benefit available to you and your family.
Rule #1 Dental insurance is not meant to be a pay-all
Dental insurance is almost the polar opposite of medical insurance. With medical coverage you meet your $1000 deductible (I’m just grabbing at numbers here) and those bigtime pay-everything-but-the-$20-copay benefits kick in. Not so much with dental. You have a maximum dollar amount that they will pay a year towards your treatment each year (usually $1000-$1500) and you will likely still pay a percentage of your treatment along the way.
Rule #2 Problems are more expensive than Prevention.
Ever wonder why your insurance company will pay for you to have cleanings, x-rays, sealants etc. but if you have a cavity, break a tooth or need to replace missing teeth their willingness to pay starts to go down? Right or wrong, if you have a problem they pay a lesser percentage towards necessary treatment (in MOST cases; we do have a few plans that pay 100% of everything!). Their willingness to pay doesn’t make the treatment less necessary, just like putting an age limitation on preventative therapies such as fluoride or sealants doesn’t mean that they aren’t appropriate for older adolescents and adults, they simply aren’t going to be paid for by your insurance company.
Rule #3 and insurance companies idea of 100% isn’t always 100%
Weird right? This is called a Fee Schedule. For example, a routine cleaning and exam in our office is typically $124 and your insurance company will probably say they cover 100% of this preventative service. Well, sometimes their fee schedule is set in such a way that they’ll pay 100% up to a certain dollar amount. For example, if this dollar amount is set at $100 then you would owe the difference of $24. If you have a plan that pays in dollar amounts what is says it will in percentages, count your blessings! We’ve found that most plans will pay a percentage of our areas average fees to whomever you’ve chosen as your trusted dental professional – in-network or out.
Rule #4 The amount the insurance company is willing to pay is determined by how much you (or your employer) paid for your plan
This is definitely one of those times that you’ll get what you pay for. A buck a month dental plan will land you in the land of ‘ I have to drive HOW far to have my teeth cleaned for free?!’.
Bottom line. NOTHING that we do is cheap.
So the big question is ‘why’. Why would you choose not to contract with my insurance company? My visits would be so much cheaper if you did! Well, the bottom line is that NOTHING that we do here is cheap. It may be ‘less expensive’, but never cheap. We at the Smile Design Centre won’t give you a product or provide a service that’s ‘cheap’ (don’t get me wrong, I shop the dental supplies companies for deals like it’s my job! Because it kinda is 🙂 I’m not picking up low grade products, just the premium products at the lowest price. Think Marshalls.). In the future we may contract with some selective dental insurance companies which may help lower your co-payments, but keep in mind, we won’t let it compromise the quality of care we provide. With a single dentist we’d have to make unfavorable changes, but who knows what the future holds? Right now, we’re thankful that you’ve chosen us and appreciate our service value. If it weren’t for your loyalty we couldn’t do what we love!