Choosing a Dentist based on Dental Insurance

The practice and business of dentistry, along with insurance, have changed in the past several years. Choosing a dentist is a very important decision. A person has only one set of adult teeth, and these teeth need to last a lifetime.  With proper care and attention, most healthy adults should be able to keep their teeth for a lifetime!

Brushing and flossing are very important to a healthy smile. Regular dental check-ups are also necessary.  One can’t visualize their teeth and determine if there are problems, and therefore a dentist is needed to evaluate one’s teeth and gums.

There are many factors in choosing a dentist.  Many select a dentist based on “non-dental” considerations.  Some of these may be location, ease of parking, hours of operation, etc.  Some select on “word of mouth” recommendations by friends, fellow workers, and family members.  Today, many people select and choose a dentist based on insurance.  Those in the United States who have dental insurance have the opportunity to have a portion of their out-of-pocket expense lowered by payment by a third party, dental insurance.

Dental insurance has changed significantly during the past several years. The majority of dental insurance companies today have Preferred Provider Organizations (PPOs).  These organizations or plans are the primary framework for benefits for those who have dental insurance.  Patients always have a choice when choosing their dentist, but it is highly recommended by the insurance companies that patients choose dentists who are contracted, “signed-up” providers with the dental insurance companies.

If a patient chooses a contracted dentist, their out-of-pocket expense is less than choosing a non-contracted dental provider.  But it is also a great financial benefit to the insurance company as it pays much less to one of its contracted providers than to a regular, non-contracted dentist.  One can easily see why the insurance would want a patient to go to a “contracted/insurance dentist” as it pays much less to one of “their providers” than a “non-contracted dentist” that has no legal/contractual affiliation with the insurance company.   Some estimates are that insurance companies may pay anywhere from 20-60% less to contracted dentists and therefore have much higher profits and make as much as 60% more if patients go to their selected contracted providers.

Dentists are solicited by insurance companies to “sign up” to become providers with the insurance company.  Insurance companies will lead dentists to believe that they will gain new patients by being a preferred provider.  But that comes at a cost to the dentist.  When a dentist signs the many times, multi-page contract with the insurance company, he agrees legally and contractually to a schedule of fees that may be 20-70% less than their normal fees for services.  Therefore, a dentist provides services that are discounted to the patient and insurance company of many times half the price or more.

Some thoughts to consider when selecting a dentist based on Dental Insurance….

* Would you select a dentist who has a contract with your dental insurance company for the fees charged?

*  Do you feel comfortable with a dentist who has a legal/contractual relationship with the insurance for dental services?

* Keep in mind that your coverage and choices may be limited due to contract(s) between a dentist and the insurance company on your behalf.

* In-network, contracted dentists have, by contract, many guidelines set forth by the insurance companies that may affect your dental care.

* Out-of-network, non-contracted dentists have no direct limitations set forth by an insurance company that would affect your treatment or choice.

* Out-of-network dentists have no contractual relationship with insurance companies and are not directly limited and dictated by an insurance company.

We hope that this information has been helpful to you as you look at dental insurance as a criterion in selecting your dentist for you and your family. Dallas, Texas dentist, Dr. William Mille,r is an experienced general dentist who has been providing his very best in personal, quality-focused dental care for over 30 years.  He works with one patient at a time so that he and staff may devote 100% of their time to YOU during your scheduled visit.  Dr. Miller practices dentistry as an Out-of-Network provider for all insurance companies.