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Insurance Questions

How does a dental insurance plan work?


Dental insurance works differently than health insurance. In reality, dental insurance is more like a gift card than an insurance policy, as it only covers a specific amount of expenses per year regardless of your needs. For example, if your plan covers a maximum of $1,500 in expenses each year, the insurer will not pay anything beyond this amount regardless of the circumstances.

Although premiums are increasing, the average annual maximum payout has not changed much in the last few decades. However, dental insurance plans are increasing restrictions on the type of care they cover. If you are scheduling a treatment that may be covered by dental insurance, we will contact the insurer to find out how much they will pay prior to scheduling your service. At the time of your service, you will only be required to pay your portion of the bill. For patients who can’t pay in full upfront or would rather have more time to pay, Santa Rosa Dental is proud to offer financing options through Care Credit.

Which dental insurance policies do you accept?


Santa Rosa Dental accepts all dental insurance policies that permit patients to choose their own dentists. We do not sign any insurance contracts that would limit the use of high-quality materials or labs, nor do we sign contracts that would limit the amount of time we are able to spend with patients. Spending time listening to our patients, using high-quality dental materials, working with the finest labs and providing safe, comfortable care will always be our priority.

The majority of dental insurance plans allow patients to select dentists on their own, as well as the level of dental care they need. However, HMO/DMO managed care plans tend to operate differently. In addition, plan benefits from the same insurance carrier may differ according to your employer. If you want to know how you can use your dental insurance plan in our office, please contact Santa Rosa Dental and we will help you understand the details.

Remember that any pre-treatment authorizations we receive are only estimates of your coverage. Although they are more than likely accurate, they are never a guarantee of payment by your insurance company.

If my employer offers more than one dental insurance plan, which one should I pick?


One of the most important considerations when comparing dental plans is whether you will be able to choose your own dentist. The best plans will allow you to choose a dentist with little or no restriction.

The best plans will also structure benefits based on the average fees charged for dental care in your area. For example, if a plan states that it will pay 100 percent of your fees for a cleaning, there is likely a limit to the charge that will be covered. A lesser plan will impose the same limit on all clients, while a better plan will base its limit on the average cost of similar services in the area. Before choosing a dental insurance plan, ask to view and compare the maximum contract allowances each plan includes, rather than basing your choice solely on the percentages.

Almost all dental insurance plans will give you the option of having the insurance provider pay the dental office directly so you only have to pay your portion at the time you receive treatment. This option is known as “assignment of benefits. With the exception of plans by Delta Dental, the majority of dental benefit plans acknowledge patient requests for assignment of benefits even when the dental office does not have a contract with the insurance provider.

If you are currently covered by a plan that doesn’t allow you to assign benefits regardless of contract status, does not have reasonable maximum contract allowances and/or won’t allow you to use the dentist of your choice, it may be in your best interest to ask your employer about the other options available.

My employer doesn’t offer dental insurance. What can I do?


If your employer doesn’t offer a traditional dental insurance plan, other options may be available. For example, some employers now offer flex spending plans in place of traditional insurance. Another option your employer may offer is a direct reimbursement plan, in which the employer will reimburse you for a specific dollar amount or a percentage of your annual dental care expenses. In most cases, you will need to provide a receipt in order to receive this reimbursement.

If you are working for an employer who doesn’t offer any dental care benefits, or if you are self-employed, you may consider purchasing a medical insurance policy that allows you to open a Health Savings Plan, or HAS. You will be able to make tax-deductible contributions to this plan each year, which can be withdrawn tax-free as long as you are using them to pay for dental and/or medical services. In addition, your account balance will earn money tax-free, and the balance will roll over from one year to the next. Keep in mind that an HSA is not the same as a flex spending account, in which the balance is lost if it isn’t spent by the end of the year.

Some patients have asked whether it’s worth the money to buy your own dental plan as an individual. However, we don’t generally recommend this practice. In most cases, because of waiting periods and restrictions, these plans charge more in premiums than you will ever be able to recover in benefits. Larger plans purchased by an employer, on the other hand, are cost-effective. The premiums paid by employees who don’t go to the dentist cover the loss the insurance company would incur if everyone used the plan, allowing for lower premiums overall.

Dental care can be costly with or without insurance. Unfortunately, as many as half of all adults have gum disease, and cavities affect both children and adults all over the country. To reduce the risk factors for dental problems, be sure to use remineralizing toothpaste and mouthwash, watch what you eat and practice good oral hygiene. Routine preventative care and fixing problems as soon as they are discovered will also reduce the long-term costs of dental care.

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