Dental Insurance, Facts and Fiction

Some Facts about Dental Insurance and Payments

• • Please note that if you have any dental PPO coverage you still may have services completed within our office. Your PPO carrier will still pay their portion for services but at a lower schedule.  Therefore, your “out-of-pocket” expense will be higher.  If you have HMO/DHMO coverage they will not pay at all for any services within our office. (With an dental HMO/DHMO, the insurance company selects the dentist for the patient)
  • Dental insurance is very different from typical medical insurance coverage.  It is basically a pre-payment arrangement between an employer and an insurance contractor.  In our office, insurance may cover only 30-50% of our fees for service.  Please remember that insurance companies are a “for profit” entity.
  • Most companies have maximum limits of $1,000 to $1,500 per year.  The maximum insurance coverage in 1959-1965 was the same at $1,000 per year.  Based on inflation alone, dental maximums per year should be at least $7,000 to $8,000 per year!

Why our policy regarding Dental Insurance is the best for YOU

• • We work for YOU and not an insurance company.  Our office believes that patients should make their own decisions regarding their dental treatment.
  • Insurance is very confusing to most.  We will be happy to answer any questions you may have about insurance.

Dental insurance is a contract between typically an employer/covered entity and the dental insurance company.  Benefits are based on a contractual obligation between the two parties and determined by zip codes.  A patient’s coverage is solely based on that contract.  Patients have no control over coverage they may receive.

Dental insurance companies also solicit to dentists to become “participating providers” by signing a contract with the insurance company to provide dental services.  Dentists that sign a contract with dental insurance companies are contracted with them and must abide by the specifics set out by the agreement.  What treatment a patient may receive may be highly influenced based on the specifics of the contract.   

William H. Miller, D.M.D. is not a contracted provider for ANY insurance company.  He has not signed a contract with any dental insurance company that may influence  treatment with a patient.  He listens and works with his patients in developing dental treatment plans. 

At this time our office is happy to file your dental insurance provided we have correct information from the patient.  A patient may also option to receive a receipt for paid services and file their own claim as well.  Regardless, of how the claim may be filed, the PATIENT WILL RECEIVE BENEFITS DIRECTLY FROM THE INSURANCE COMPANY. 

Our office does not accept insurance assignments.  Therefore, services are paid to our office at time of service by the patient and the patient receives payment from the insurance company.