For our patients who are fortunate enough to have dental benefits, we offer the following information to help understand dental insurance coverage.
Do you participate with my plan?
Participation means that we have agreed to the fee schedule as provided by your carrier. This means that you will never pay more than the lowest possible fees for your plan. Your employer will decide how much of these plan fees are your responsibility and how much will be paid by the insurance company.
We have contracts with the following insurance carriers:
- Aetna PPO
- Cigna PPO
- Guardian PPO
- MetLife PPO
- United Healthcare PPO
- Delta Dental PPO
- United Concordia
- Dominion Dental PPO
- Assurant Employee Benefits
- Principal PPO
- Humana PPO dental network
How much does my plan cover?
Dental Insurance sales people will tell you that their plan will cover 80-100% of your dental fees. What they don’t share is the fine print. In reality most dental benefits plan cover between 40 -60% of dental service fees. Dental insurance was never designed to pay for everything. Unlike health insurance it has a contract maximum, deductibles and percentages. These amounts change every time an employer renews the plan.
What does PPO (Preferred Provider Organization) mean?
A practice is considered “in-network” when the dentist has a agreed to accept the fees set by the insurance carrier. While in many practices this means a substantial savings, at rainbow valley dental we offer low fees everyday. We are currently working with Aetna a MetLife, Cigna, and Guardian to join their networks. Some carriers network fees require “loss leader” services. At this time we are unable to join any networks that reimburse at below cost rates.
Why is made in the USA important in dentistry?
Many insurance networks have made special pricing deals with large laboratories to provide dental appliances (such as crowns, bridges, dentures, implants, partials, night guards etc.) at significantly lower costs to the participating practices. These labs routinely outsource these medical devices to overseas labs that are not under the guidelines of the FDA. We will never outsource our laboratory work.
What are DMO’s (Dental Maintenance Organization)?
Much like an HMO in medical care a patient covered by a DMO contract will only receive benefits at the DMO dentist that has been selected for them. The DMO practice is paid a monthly stipend for their DMO patients whether they seek treatment or not. Many DMO patients who are unhappy with their DMO dentist seek dentistry outside of the network and choose a non-DMO plan when they are able.
Will you bill my insurance directly?
Rainbow Valley Dental submits claims to most major insurance carriers electronically each day. We ask that insurance patients pay a deposit for their care at the time of service and maintain a form of payment on file to cover the balance when the insurance benefits are received.
My insurance company says I will save money with an “in-network provider”
The answer is on some procedures yes and some procedures no. Most in-network providers have higher regular fees to allow them to offer the huge discounts. We prefer to just start with lower fees and be able to provide the best possible treatment options to all of our patients. We belong to networks that offer fair and reasonable reimbursements.
Can I spread out my payments?
Of course, we offer CareCredit patient financing to provide interest free option for spreading out dental treatment fees. Simple application is required and this re-usable line of credit can be used for an entire family.
My insurance covers very little- why is that?
Dental benefits are what you pay for. The primary goal of a dental Insurance carrier is profit for their shareholders. So they make sure their contracts are written in such a way that employers and individuals pay more for plans that they pay out in benefits.
My explanation of benefits is very confusing.
We will help you in any way to understand your benefits and get the maximum benefits you are entitled too.
Is there an individual dental insurance plan that you recommend?
Yes, we have had many patients who have purchased AFLAC individual dental insurance. The benefits improve the longer you keep the plan. Visit the AFLAC website to learn more.