About Insurance, Payment and Privacy

Can I see a dentist without dental insurance?

Is it possible to afford quality dental care if you or your family doesn’t have dental insurance? Absolutely. But to understand how, you’ll first need to know what goes into the benefits that you might be “missing” should you drop your coverage.

What does dental insurance pay for?

Nearly all dental insurance plans are prevention-focused. What that means is that they “pay for” preventative services like two checkups and cleanings per year, plus any necessary X-rays. When restorative procedures like fillings or crowns are needed, the insurance plan pays for less on the service, and only after a specific dollar deductible has been paid by the patients. More involved or complex treatments are covered at even less. Don’t forget the “maximum allowable” amounts that once met, mean your insurance won’t pay anything more until the next calendar year. Additionally, elective services such as cosmetic procedures are not covered at all.

How much does dental insurance really cover?

Once you’ve done the math, the money that you pay into your dental insurance policy each year is about as much as what it would take to pay for your six-month preventative care appointments, plus a little more. If you’re not one to usually have many dental problems, it may actually be more cost effective to pay out of pocket than it is to enroll in a dental insurance plan. Insurance allowable amounts usually cap out at around $1,500 per year. Surprisingly, this amount has not changed in over four decades. While medical insurance coverage has adjusted with the cost of inflation, dental policies have not. That means you’re getting the same about of coverage as a family did in the 1970s…so when you need extensive restorative or rehabilitative care, practically no one will be able to say their insurance covers everything.

What are complimentary cash discounts?

Deciding to go to the dentist without insurance means you’ll be paying for your service at the time of the appointment. If you’re writing a check or paying by cash (and no credit card fees are involved,) most private practices will include a courtesy discount of around 5-8%. Seeing a dentist without dental insurance is quite similar to fee-for-service dentistry, where the patient pays for their appointment and is then partially reimbursed at a later point directly by their insurance carrier.

How can I keep dental costs down?

Most oral health concerns are preventable. By choosing to see your dentist every six months, you’ll be equipped with the tools and information that you need to lower your risk of tooth decay and gum disease. Additionally, your dentist can diagnose concerns at earlier stages. Treating areas of decay or infection earlier means less-invasive therapies that are more affordable. Such treatments are also healthier for your teeth, because less tooth structure or soft tissues are involved.

Do dental insurance benefits expire?

If you’ve been waiting until after the holidays are over to catch up on your dental care, think again. You could be throwing away hundreds to thousands of dollars by simply delaying your appointment for a couple of weeks. Why? Because every January 1st, most dental insurance policies reset. That means any funds available to cover necessary oral health services during this calendar year go away.   This can be a good and not so good thing. For example, if you’re waiting to start on a necessary procedure, it means putting the treatment off until January will cause you to lose the benefits you’re still entitled to for 2019. But if you start treatment before the end of the year, your allowances re-set at the new year, so that you can address additional treatments you need (without hitting your yearly allowance so early on.)   Remember, most dental insurance plans are designed to promote preventative care. So, your cleanings and exams are typically covered 100% twice per year. If you don’t use those allowances, you lose them. They do not roll over until the next calendar year. By scheduling a checkup every six months, your dentist can intercept any developing issues while they’re still reversible or more affordable to treat.   As with any type of dental treatment, your Kois Dentist will have financial coordinators who help to break down your benefits and allowances, so that you know exactly what to expect when it’s time to schedule a treatment, be it a small filling or a dental implant supported All-on-4 prosthesis. When there are portions of your care plan that aren’t covered by yearly benefits, it may be possible to schedule them a month later when your benefits reset. If not, flexible financing is also available!

Does insurance cover cosmetic dentistry?

You’ve been considering a smile makeover, but one of your friends recently had several cosmetic dental procedures and told you that everything had to be paid for out of pocket. Is it possible to use your insurance benefits to cover your cosmetic dentistry treatment? Understanding what differentiates your procedures from “elective” and “restorative” is the key differentiator.

Are some restorative treatments considered cosmetic dentistry?

Let’s start with restorative dental treatments, which are almost always covered under your dental insurance. Restorations include things like fillings and crowns. It can also include dental implant therapy, depending on the specifics of your plan. Restorations can be made in a manner where they are aesthetically pleasing, thus making up a crucial part of your smile makeover. For example, white (composite) fillings and porcelain dental crowns protect and restore your teeth. But they’re also made using cosmetically pleasing materials that enhance the appearance of your tooth during the process. Regardless, they’re an essential procedure used to achieve a better level of oral health. When your dentist uses white restorations due to physical damage to your teeth, you have a better chance of them being covered by your dental insurance.

When are treatments considered “elective”?

An elective dental procedure is one that you choose to have completed, even if you don’t need it for health purposes. For example, if your teeth are free of decay or disease, but you don’t like the way they look, having them enhanced would be an elective procedure. Dental insurance usually does not cover elective types of dental procedures such as cosmetic dentistry. Some common examples would include cosmetic veneers or teeth whitening. There will, of course, always be exceptions to the rule. Perhaps you have a type of irregularity on a front tooth that needs to be repaired, but a dental crown will be too aggressive to the rest of the tooth structure. A veneer or cosmetic bonding would be less invasive and serve as a restorative-type procedure. Your dentist will likely have to submit case notes, photographs, and X-rays to the dental insurance company to convince them to pay for the treatment.

A Combination of Treatments

Every smile makeover is unique. Your dentist will evaluate your needs on a comprehensive and tooth-by-tooth basis. In some situations, a variety of restorative and elective treatments are used to achieve an overall goal. If you need to whiten your teeth before replacing a single porcelain crown (crowns can’t be whitened after they’re placed, so it’s best to start with a lighter color from the start) you would have to pay for the whitening out of pocket, before filing the crown against your insurance benefits. As part of your cosmetic dentistry plan, your dentist will provide a variety of options and a detailed breakdown as to what’s covered (or not) by your benefit package. In most cases, you can easily finance the portion of your treatment that isn’t covered by insurance, making it more affordable. If your insurance pays more than you expect, you’re left with a lower out-of-pocket amount.

What is “Fee-for-Service” Dentistry?

When you hear the words “fee-for-service dentistry,” it may sound like a deterrent. Does it mean cash only? No insurance accepted? Here’s what the reasoning behind fee-for-service really is, and how it can benefit the care you receive. Quality Over Quantity Some dental patients feel restricted by their dental insurance, in that they’re not able to select a provider that offer the level of quality care they are looking for. However, many fee-for-service dentists do accept insurance, even if they do not participate as a “preferred provider” in the plan that you carry. Working outside of the network allows the fee-for-service dentist to charge a fair and fixed rate for specific procedures that they offer, rather than have their fees managed and dictated by a third-party insurance provider. This measure allows dentists to utilize the highest quality labs and materials, rather than having to select lower-quality facilities in order to meet cost restrictions. As a result, patients will be able to receive excellent care that isn’t restricted by an insurance carrier’s contract. Payment at the time of service A fee-for-service dentist may request payment one of two ways: having the patient pay for their services in full at the time of treatment (to be reimbursed directly by their insurance carrier) or paying the copayment then any remaining balances not included in their insurance benefits after the claims have been processed.   Either method, the patient is paying the same amount. It’s just a matter as to whom is being paid by the insurance carrier and how quickly their account is resolved at the dentist’s practice. Some insurance companies prefer to reimburse the patient directly, making it more cost-effective and efficient for all parties involved to pay for the dental treatment at the time of the appointment.

What happens once insurance is filed?

Depending on your dentist’s financial policy, many practices are happy to file insurance claims on their patients’ behalf. Even though you are paying the office directly, they manage all of the paperwork and forms that are needed to seek reimbursement for your plan’s coverage. It’s important to note that insurance claims can take well over 30 days or more to file, process, and a reimbursement check sent out. Once it arrives, the payment should be made and mailed directly to your home address.

What is the advantage for patients and dentists?

Fee-for-service dentistry is a deterrent for some individuals when seeking out a new dentist. But the truth is that when you need the best care at a competitive rate, seeking out a fee-for-service dentist provides both you and your dental practice with more freedom in regard to what’s possible for your smile. The fair pricing allows your dentist to select the best procedures and methodologies, rather than the ones that will “only fit into the plan’s package.”


Release Forms

Before your dental insurance can be filed or a treatment plan discussed with your loved one, you’ll need to sign appropriate release forms with your dentist’s office. Otherwise, they legally cannot process claims or review concerns with your family. For more information or specific questions about what your dental provider does to protect your private information, ask to speak with the practice or office manager.

Patient Education. (n.d.). Retrieved May 2020, from www.koiscenter.com/patient-education