Dental insurance these days is one of the most confusing benefits programs provided, for both patients and dental offices. It seems that the most common dissatisfaction with dentistry has less to do with the quality of dental service and more to do with the surprise bills, limitations, and exclusions for coverage, and the complex algorithms that require both a dental degree and a career in quantum mechanics just identify if your dental needs have coverage.
Despite the insurance challenges, Walden Dental goes well beyond the typical dental office to provide every detail possible about what coverage you can expect from your insurance based on your individual plan. Once you call, text, or use the Walden Dental website’s online appointment booking, we’ll collect from you all the necessary information about your active insurance plan. Not only does Walden Dental prepare for your clinical needs, we immediately begin to verify with your insurance what will be covered. This includes calling your insurance company, requesting faxes of your benefits details, identifying exclusions, limitations, and other factors for your plan’s policy that may interrupt your coverage. We’ll also ask for dual insurance benefits if applicable and verify if one or both will offer added value. With this level of diligence, it’s no wonder our patients consistently appreciate and mention in online reviews how well their dental needs and insurance benefits are explained, while accounting for their time and budget.
Does my insurance cover everything?
Only in rare circumstances will dental insurance cover everything. Typically, the most common procedures your insurance covers in-full are “preventive” by classification. These dental benefits are usually for perfectly healthy mouths and are services your dentist provides to complete a routine check-up and cleaning. Beyond radiographs (x-rays), a healthy mouth/gums cleaning, and dental examination, there will be out of pocket expenses for your care.
The Percentage of Coverage for your benefits
For our in-network insurance patients, [full list of insurance accepted] your insurance dictates all fees charged, co-payments due, and any additional out-of-pocket expenses. We are under strict obligation to follow the exact terms and conditions of your plan. Your insurance will categorize common types of dental treatment into minor and major restorative services. The classification of coverage is used to determine the percentage of benefits paid by insurance and paid by the member (you). Treatments like fillings are usually identified as minor, whereas crowns, onlays, dentures, bridges, etc. are deemed major services that usually have percentages of coverage at 50% as compared to the minor services typically seen at 80%. The amount payable is directly determined by your plan. Some plans have higher percentages, some have lower, and others still may not cover most restorative dentistry. Please keep in mind all fees discussed are dictated by your insurance company’s plan that you elected, but these do not dictate what treatment decisions you and Dr. Frank deem best for your individual needs. Deviating from the policies set forth by your insurance is fraudulent and considered to be a felony offense. Walden Dental will do everything to maximize your insurance savings but only within the bounds set by your insurance.
Which insurance is best to get?
We are asked this question multiple times a day. In participating with more than twenty insurances, we can convincingly claim that no one insurance is best. Frankly, all insurances have a similar set up with their own pros and cons. Some plans offer a wider range of coverage but have higher monthly premiums and longer waiting periods. Some plans have lower fee schedules but carry extensive limitations and exclusions to dental care. Some will cover only corrosive and highly irritating metal restorations to fix your teeth despite these materials suffering from inferior survival rates, and most cap your benefits to a lower dollar amount that excludes coverage for substantial dental work. Don’t misunderstand us, we think having insurance is better than not having insurance altogether as even limited coverage still typically adds up to significant savings for you. Understanding this, please don’t confuse dental insurance as a source that will pay for most of your dental care, or that it provides tailored benefits ideal for your individualized long- term success.
For our patients that don’t have insurance, please enjoy the benefits of the Walden Dental Plan. You may find our plan offers superior benefits for your particular needs that most insurances cannot accommodate.
Dental Insurance Exclusions and Limitations
Some patients have dental needs requiring treatment that insurance plans deem unnecessary, or it’s outside of the bounds of coverage. Examples of these exclusions include no coverage for white (composite) fillings on back teeth, no coverage for white (ceramics) on pre-molar and molar teeth, no permanently fixed bridges or dental implants for teeth that are currently missing, and/or no dentures despite you missing teeth (yes, you read that correctly). These scenarios typically occur with the dreaded waiting period in which you must wait 12-18 months before your insurance will contribute towards your treatment, even in the face of severe tooth pain, gum and/or bone infection. Not only will your mouth’s pain and damage continue to worsen, the secondary effects of these infections often contribute to heart disease, diabetes, complications with fetal development, and a decline in sexual performance. We are equally offended to know your level of insurance benefits are based on costs to the insurance company and not your individualized health, however, we recognize it’s better to have some level of coverage than none altogether.
We know you want to keep your teeth healthy and maintain an attractive smile. Although we create relationships and experiences that are custom made for you, your insurance does not work in the same manner. Our commitment to you is to optimize your oral health, respect your time and budget, and work within the parameters of your dental benefits. We too are discouraged that insurance policy plans don’t take your specific needs into account, but let’s not let that interfere with the quality of health you deserve. We are passionate about providing the care you need and have partnered with multiple financial services to help eliminate barriers to treatment. Let’s work together and no let your plan’s limitations compromise your overall health.