Complete List of Dental Insurance Plans
Dental Insurance. Dental insurance is a “future risk” contract between you and your insurance carrier, in many cases, coordinated with your employer. You pay monthly premiums to the insurance company to assume some of your risk of future dental expenses. It is designed to help pay a portion of the costs associated with "medically necessary dental care", defined as treatment essential to "maintain or restore to normal health". Dental insurance does not pay for "discretionary or elective" treatment, i.e., teeth whitening or cosmetic veneers. Dental insurance never assumes 100% of the risk, so it never pays for 100% of your dental care. Otherwise, you would be unable to afford the high cost of premiums, deductibles, copayments and coinsurance. It is important to note that insurance companies can only authorize payment, not treatment. Treatment can only be authorized by a licensed dentist.
Policy. Your insurance policy dictates the amount it pays (allowance) for each dental treatment. It is important that you read your policy, or talk to your insurance representative, so you can understand how your insurance plan helps pay for treatment.
EOB. After treatment, your insurance plan will provide an Explanation of Benefits (EOB) dictating allowances, how benefits were applied, how payment was determined and your portion of the bill you are responsible to pay. You should talk to your insurance representative to understand your EOB.
Networks. Some insurance plans contract a fee schedule of allowances and covered benefits with a network of dentists known as the insurance plan's "network". The allowance dictates the ceiling on each fee for each covered benefit. Contracted dentists are “in-network”, and non-contracted dentists are “out-of-network”.
PPO. A Preferred (also Participating) Provider Organization (PPO) is a network of dentists contracted to provide care at specific lowered rates (allowances). Some PPO's pay only for dentists “in-network”, while others let you see your dentist “out-of-network”. Depending on your particular PPO plan provisions, if you seek care from a dentist “out-of-network”, you will either not receive any coverage at all, or you would simply exceed the allowance, and pay the difference for higher quality.
In Network: Good Quality - Good Value. AAA Dental, located inside Four Seasons Dental Spa, is “in-network” for most contracted PPO plans. For patients who are treated “in-network”, AAA Dental is a quality mercury free practice. For an extra charge, AAA Dental offers high quality white Nano composite fillings that are an upgrade from the typical dental insurance mercury downgrade! When AAA Dental is “in-network” for your plan, and the fee exceeds the allowance, we adjust off the difference between the AAA Dental fee and the allowance. For example, if a crown cost $1200, and you have paid the deductible, and your insurance plan pays 50% of the allowance of $1050, or $525, your portion is 50% of $1050, or $525.
Out of Network: Highest Quality - Best Value. All dentists and specialists with Four Seasons Dental Spa are “out-of-network” for all insurance plans, offering absolutely the finest quality materials and advanced technology available today. Dr. Wright always works in microscopic surgical loupes (binocular microscopes used in surgery) for a more precise result. This allows him to see at a magnified level enabling him to remove decay that he would otherwise not see with the naked eye. It also enables him to get a microscopic seal on crowns, helping to avoid leakage, future decay, root canals and tooth loss. Dr. Wright’s filling fee includes an upgrade to the safest and highest quality white Nano-hybrid resin composite fillings and bonding materials. In laboratory tests, these state-of-the-art fillings strengthened teeth 7-8 times! Dr. Wright is a holistic, mercury free, mercury safe dentist. When removing mercury fillings, he follows the standard of The International Academy of Oral Medicine and Toxicology (IAOMT) at no additional charge. He also offers additional measures to protect you from toxic mercury particulates and mercury Hg gas vapors for an additional charge. When the Four Seasons Dental Spa fee exceeds the allowance, your insurance plan permits you to pay the difference for higher quality services and materials. For example, if a crown cost $1200, and you have paid the deductible, and your insurance plan pays 50% of the allowance of $1050, or $525, your portion is 50% of $1050, or $525 + $150 (the difference between crown cost and allowance).
Payment. We are not guaranteed that your insurance plan will pay for treatment. We file insurance claims for you as a courtesy, but we have no control over your insurance benefits or payment. Even after payment is received, insurance plans often modify the benefit and payment subject to internal audits and reviews. If your insurance plan does not cover a procedure, you will be responsible to pay 100%.
Patient Responsibility. Dental insurance can be very confusing, and to make matters worse, every insurance plan handles things differently. Most insurance plans require you to pay an annual deductible and copayments or coinsurance. Your deductible must be paid each year before insurance benefits are paid, while copayments and coinsurance are your portion of the bill that is not paid by your insurance plan, as dictated in your EOB.
Cost vs. Benefit. Many insurance plans exclude common treatments such as implants, white fillings, bonding, laser surgery, laser gum treatment, VELscope oral precancer and cancer screening, and even some periodontal care. In order to lower premiums, more and more employers and patients are choosing insurance plans with higher deductibles, copayments and coinsurance, and fewer benefits.
Quality vs. Value. Homes, automobiles and dentistry are available in many different prices and qualities of materials, workmanship and artistry. In many cases, your insurance plan will "downgrade to an alternate benefit" that covers only the least expensive dental treatments and materials. An example of a typical "downgrade" is mercury fillings. Instead of downgrading to mercury fillings, we offer only safe, high quality, white composite fillings. It is common for patients to choose higher quality treatment and materials than what insurance allows, paying 20-30% more for results that look and feel better and last longer. They realize that buying higher quality today is a better future value.