How does dental insurance work?

Dental insurance isn't actually insurance, it's a benefit plan that only about half of employers offer to employees and should be considered a gift card rather than insurance. Most dental benefit plans only cover up to $1500 per year and will not pay anything beyond that whether it is dentally necessary or not. That average annual maximum has not changed much in 40 years although premiums are going up and dental benefits plans are becoming more restrictive in what they will pay for. With most dental plans, we will contact your insurance plan for an estimate for how much they will pay for your care and collect just your portion at the time of service. For our many patients with Delta Dental plans, we will collect payment in full from patients at the time of their dental care and Delta Dental will send payment directly to the patient 7-10 business days later to reimburse them for Delta's portion of the treatment. We are pleased to be able to offer flexible financing through Care Credit for patients who need to make monthly payments for more extensive dental needs.

Which dental insurance plans do you take?

We accept all dental plans that allow you the freedom to choose your own dentist, although we do not directly contract with plans that would require our discounting our dentistry to appear on advertising lists. We choose to take the time to listen to our patients, provide safe and comfortable care, use the finest labs, highest quality dental materials, and adhere to the strictest infection control standards. Most plans, with the exception of HMO plans, allow patients to choose their own dentist and the level of dental care that best meets their needs. Plan benefits from the same insurance carrier can often differ significantly by employer. If you would like to know how your plan will work in our office, please call us and we will contact your dental plan to find out the details for you.

My employer offers several plans, how do I decide which to choose?

A good dental plan should allow the patient to choose their own dentist with few or no restrictions.

Better plans also pay for dental treatment based on average area fees for dental care. Some plans will tell you that they pay 100% toward a cleaning, but what they won't tell you directly is that they may only be willing to pay up to 100% of a $60 capped allowance toward a preventative cleaning compared to a better plan that will pay 100% of the average area fee of around $150 for a preventative cleaning. Always ask to compare maximum contract allowances for certain common procedures like cleanings, exams, fillings, and crowns instead of just choosing based on the percentages described by the plan.

And finally, almost all plans allow the patient the convenience to choose to have their plan send payment directly to the dental office so the patient only has to pay for the co-payment at the time of dental treatment. This is called assignment of benefits. Most all plans acknowledge a patient's request to assign benefits to their dental office regardless of the dentist's contractual agreement with the dental plan, with the exception of most Delta Dental plans.

If your plan does not allow you to choose your own dentist, does not have maximum contract allowances that are comparable to average area dental fees for procedures, or does not recognize your right to assign benefits to your dental office regardless of your dentist's contract, you may want to speak with your employer about other options they may be able to provide when it comes to dental benefits.

My employer does not offer a dental benefit plan, what are my options?

Some employers are choosing to offer flex spending plans that cover dental care instead of traditional dental benefits. Others are offering direct reimbursement plans where they will reimburse you a certain percentage or dollar amount that you spend on dental care per year provided you supply them with a receipt showing you received services and paid for them.

If you are self employed or working for an employer that offers no benefits at all, consider purchasing a medical insurance plan that is Health Savings Plan (HSA) compatible. Each year you will be able to contribute to your HSA. Contributions are tax deductible, withdrawals are tax free when used for qualified medical and dental purposes, earnings on account balances grow tax-free, and balances accumulate and roll over from year to year, unlike a flex spending account that you may lose if you do not spend it.

We are often asked if it is worthwhile to buy a dental plan as an individual. We have not found a plan that makes good sense to purchase as an individual. Most of these plans charge more in premiums than the patient is likely to actually receive back in the form of benefits due to waiting periods, non-covered services, and other restrictions. With a large group plan through an employer, the plan premiums for the estimated 35% of the enrolled employees who do not actually go to the dentist, pay for the loss the insurance plan would otherwise incur if all patients who were insured actually used their plans.

Unfortunately, it is estimated that 50% of all adults have gum disease and cavities are the most widespread chronic childhood disease in the United States. Good oral hygiene, watching what you eat, using a fluoridated tooth paste, reducing risk factors for dental problems like dry mouth and mouth acidity, routine preventative care, and detecting and fixing dental problems when they are small, are the best strategies for reducing the cost of dental care.

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1317 ninth avenue | san francisco, ca 94122 | map & directions call: 415-731-9311

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