Patient Portal

A dental benefit plan may help pay for the cost of your dental care. Generally, a dental benefit plan is a contract between your employer, or plan sponsor, and a third party (insurance company). These contracts vary widely. In addition, some employers offer flexible spending account options for dental or medical benefit needs. Check with your employer to see if a flexible spending account is an option for you. There are many ways in which dental plans are designed and how reimbursement levels are determined. You need to know how your dental plan is designed – and its limitations.

There are numerous models of dental plans available to patients. In general, they can be divided into two categories: managed care and fee-for-service. Managed Care dental plans are cost containment systems that direct the utilization of health care by a) restricting the type, level and frequency of treatment; b) limiting the access to care; and c) controlling the level of reimbursement for services. Fee-for-Service dental plans are typically freedom-of-choice arrangements under which a dentist is paid for each service rendered according to the fees established by the dentist.

Our insurance coordinators deal with many different insurance companies. Some companies offer many different dental and medical plans. These companies can change benefits, co-pays, and deductibles many times throughout the year. We do our best to provide you with accurate coverage estimates based on information available to us. At times, it is almost impossible to accurately estimate a patient’s insurance co-payment. Many insurance companies will not give out fees until after the treatment is completed. Dealing with these companies can be difficult and time consuming. As a courtesy, we ask that you keep us informed of any change to your insurance. It is important that all information about you and your insurance is current. Although we will gladly file a claim on your behalf, you may wish to submit the claim yourself. In general, insurers process claims filed directly by patients faster than those filed by the service providers (dental offices). Further, most dental insurance policies are limited and often only pay for a portion of the procedure(s) that may need to be done.

Your plan may want you to choose your dental care from a list of their preferred providers. Whether or not you choose your dental care from this defined group can affect your levels of reimbursement. For example, in a PPO or managed care dental plan, the dental insurance company has contracted a fee schedule with the dentist, who generally has an agreement with the insurance company to write off the difference in charges without charging the patient any additional out-of-pocket expense. Dr. Johnson is not a participating provider with any managed care dental plans (HMOs & PPOs). Many patients with dental insurance are not aware that they can choose a fee for service dentist – or a dentist not within their network – without having to absorb the entire cost of treatment themselves, depending on what their coverage allows. Also, recently insured people may leave a trusted dentist to go to a participating provider because they are unaware that they have an option to choose their own dentist. However, this may not always be the case when the insurance is a PPO or managed care dental plan. If a patient with a PPO or managed care plan chooses to see a fee for service dentist, they will likely have additional out-of-pocket expenses.