The Mind-Boggling Game of Dental Insurance

This is Our Mission Statement:  

“The partnership we enter into with our patients to achieve the optimum in dental and overall health, by pursuing excellence through continuing education and leading-edge technology, is one of privilege and respect.                                                                                                                                 

Our mission is to consistently provide a safe, comfortable, and efficient dental experience with empathy and compassion for every patient at every visit.”

Our service values of safety, comfort, and efficiency will always be followed in this order.  Your safety is our primary concern and will never be compromised for the sake of efficiency.  Whether it be time or cost efficiency, you will always have the time you deserve to comfortably understand your treatment and your recommended treatment will always be based on what is best for your dental and overall health.  Doctor Jeff does not treatment plan by the dictates of your insurance.

We are preferred providers in most of the popular PPO insurance plans.  The benefits of these plans are meant to assist you in affording your dental treatment.  No dental insurance pays 100% of your dental treatment plan.

We take pride in being your healthcare advocate providing you with the highest quality of care.  We also strive to make dentistry comfortably affordable.  Our team works diligently to coordinate all resources to enable you to obtain a healthy, beautiful smile.  If dental insurance is one of those resources available to you, our goal is to maximize your dental benefits and minimize your out of pocket expense.

Some Things to Know About Dental Insurance

  • Insurance companies do not give full disclosure of what will and will not be paid for.  For this reason, the best we can do is estimate benefits based on the information they do give us.
  • Dental insurance is not in the healthcare business, nor are they looking out for your best interest.  They are in the insurance business to make money by collecting premiums and paying out minimum benefits to have a net profit. 
  • The more coverage that is denied, and benefits are delayed, the more profit is made by the insurance company.
  •  The complexity of the waiting periods, loopholes, downgrades, and exclusion clauses has increased every year.  Your premiums have increased every year. What has not increased is your benefits.
  • Dental plans begun in the 1970’s and most plans had $1000 annual maximum.  Today, 50 years later most insurance plans still have $1000 maximum benefits.  The spending power of $1000 in 1970 equates to about $149 in 2020.
  • Even with a prior authorization of treatment, the insurance company is not bound to pay what they authorized.  The fine print on the document states: “coverage is not a guarantee of benefits, the final decision of benefits to be paid is made after treatment is completed.”

The bottom line is our relationship is with you NOT your dental insurance.  We will always give you all the best treatment options based on your individual situation. Dr. Schmelter does a comprehensive exam including films, photos and a face to face discussion regarding your dental and medical history as well as your dental goals. We do not recommend treatment based on what your insurance dictates you are entitled to sight unseen.

We will always do our best to avoid unexpected surprises in your dental insurance coverage. Since we value our relationship, we want to provide full disclosure that we are powerless in making your insurance company pay based on necessity of care or what is in your best interest dentally.  We would never want your dental insurance to damage our relationship with you because of a misunderstanding or lack of clarity about expectations.

But I Don’t Want to Play the Dental Insurance Game Anymore

If even after diligent efforts to understand your dental insurance benefits, you find your head spinning and, like us, you are frustrated with the lack of transparency by your plan, we have options.  Talk to us about making the smile of your dreams a reality!