Dr. Werkmeister always acts in the best interest of his patients and never compromises care based on restraints placed by insurance companies.
Dental insurance is confusing to many of our patients. The terms “yearly maximum” and “non-covered procedure” tend to send patients into panic. This section is designed to help our patients understand dental insurance benefits and how we can work together to get the most from your benefits while providing the quality periodontal care you deserve.
What is dental insurance, really?
Dental insurance is not like medical insurance, which protects the policyholder and dependants in the event of serious illness or injury. What is called dental “insurance” is really a benefit. The amount and terms of this benefit are negotiated between your employer and the insurance company. Unfortunately, the goal of most dental policies is to provide basic dental care and usually only covers a specific list of dental services.
Yearly Maximum Benefit
The yearly maximum benefit is often the cause of the most confusion. Most dental benefit plans have a yearly maximum. In this case the term “year” refers to a calendar year—January through December.
Though the amount of this maximum can vary, it is typically $1,000. Interestingly, this amount has not changed much over the past 30 years. The allowable cost of any dental visit, including routine cleanings is deducted from that amount. Once this $1,000 limit is reached, the policyholder will not be reimbursed for any other dental care, regardless of need.
A yearly maximum may be sufficient for those needing minimal dental care, but for those with extensive problems that require a more detailed treatment are often left without coverage for necessary procedures.
Covered and Non-covered Periodontal Care
Dr. Werkmeister will only perform procedures that are in your best interest and necessary to your overall dental health. Unfortunately, there is the possibility that not all of the periodontal procedures you need will be reimbursed by your dental benefit plan.
Our goal is to give you the best treatment we can. The goal of the insurance company is to provide a negotiated benefit for a select list of dental services. The benefit that you receive from your insurance company is in no way connected to your specific need to maintain optimal oral health.
Pre-determination Policies
A pre-determination policy does not authorize or guarantee payment for your procedures. This step requires that the policyholder receive an “estimation of dental benefits” prior to treatment.
We believe that this pre-determination process delays treatment. Our staff is happy to contact your insurance company to obtain your benefit information by phone.
We believe that helping our patients through the confusing dental insurance policies is part of our service to you. We always complete and submit required forms in a timely manner and, when necessary, provide additional documentation.
If you have any difficulty receiving your insurance payment, please let us know. We will continue to work with you to be sure that you receive your maximum benefit. Please keep in mind that some companies do process faster than others.
If at any time you have questions about your treatment needs and how it relates to your dental insurance benefit, please ask us.