Covered vs. Non-Covered Services


Understanding Dental Insurance Benefits:

Dental insurance is a valuable way to help pay for dental care. It can incentivize preventative dental care and reduce your out-of-pocket cost for treating your dental problems. Unfortunately, some of the services you may need or desire are not covered by your dental insurer. It is our ethical obligation to optimize your dental health without the bias of dental insurance coverage. Our goal of providing exceptional dental care is not necessarily shared by your dental insurance plan. The insurance company’s goal is to provide the negotiated benefits for specifically selected services at the lowest possible cost according to the insurer's contract.

The reimbursement mechanism from your dental insurance company is a formula for the benefits you will receive to cover a certain percentage of a discounted dental service fee. Out-of-pocket payment makes up the remaining percentage of the discounted fee. Discounted fees are determined by a preconceived formula based upon “usual and customary” fees in a given area an insurance company is willing to pay. Fees determined by this method are often significantly lower than  average fees in the area. Although we provide affordable dentistry, in order to invest in high quality materials, staff and training, we choose not to compromise your care based upon the arbitrary price restraints imposed by insurance plans.

Dental insurance is very different than medical insurance! Medical insurance, funded by high monthly premiums, often provides payment for covered services up to a very high limit once a significant deductible is met. In contrast, dental insurance, funded by low monthly premiums, is a 3rd party payment plan which covers a percentage of discounted covered services up to a low fixed limit each year. In this way, medical insurance can cover catastrophic and large dollar amount procedures, while dental insurance provides coverage for episodic and small dollar amount services. Dental insurance is a great way to try to maintain dental health with preventative services and treating problems concerning a few teeth at a time. However, it may be insufficient to get your to optimal dental health. Some people may have more comprehensive and complex dental needs, leading to dental service recommendations that exceed your arbitrary covered services and yearly limit. Once this limit is reached, no other benefits for services will be provided by the insurance company, regardless of the need or how essential the service may be for your dental health. We promise to help you get the dental benefit you deserve, but be aware your dental plan alone may not help you achieve your best dental health. It is ultimately up to you how much you want to invest in your dental care, and we will adapt to your desires within the standards of care.