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Neil Priske,D.D.S.(818)249-6133

Dental Insurance-The Facts

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A guide to help you understand dental insurance options

   Dental Insurance has benefited many patients and dental offices over the past 40 years. It has allowed thousands of people to take better care of their teeth and has brought many new patients into dental offices.
   But now, we are seeing a significant increase in 'managed health care' companies that decrease patient's freedom of choice and many believe decreases the quality of care as well.
   Your employer may present you with this option in order to reduce their benefit costs. You can use this guide to assist you in understanding and comparing the various benefit plans.

FACTS
#1 Your insurance plan is a contract between your employer and the insurance company. All patients are financially responsible for their accounts. The insurance company is responsible to the patient. Specific questions should be directed to your insurance carrier or your employer.
 
#2 No insurance plan covers all dental expenses. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. It is the patient's responsibility to pay any deductible amount, co-insurance, or any other balance not paid for by their insurance company.
 
#3 Many routine dental services are not covered by insurance companies.
 
#4 The benefits received by an insurance company are determined by how much the employer pays for the plan. The less expensive the plan, the fewer the benefits.
 
#5 Insurance companies are in business to make money. They make more by paying fewer benefits. They also profit more by waiting to pay claims and by making dentists send in pre-estimates on the more expensive procedures. Delays in treatment results in less treatment.
 
#6 It has been the experience of many dentists that sometimes insurance companies tell their clients that certain dental fees are 'above the usual and customary' or UCR, rather than tell them that the insurance benefits are too low. We know that some insurance companies do not upgrade fee schedules regularly, even with the cost of living index.
 
#7 In 1971, dental insurance benefits for a year were approximately $1,000. Although insurance plan premiums have greatly increased over the years, many plans still have the same maximum annual benefit. Adjusting for inflation, insurance maximums should be at least $5,000.
 
#8 Dentists who sign up to participate in 'managed' health care' plans agree to accept a significant decrease in their fees for the services they provide. This is why, we choose not to participate in 'managed health care' plans.
 
#9 With the increase of 'managed health care' plans, the patients are losing their right to choose their own dentist. They are restricted to a list of dentists who agree to accept a lower fee. Also, these plans cause the patient to lose more and more of their freedoms and coverage of quality denstistry, and the dentists receive less compensation for their services.
 
 
 
 
 

   The list below will help you understand the major differences between the three most popular plans of dental benefits.
 

Traditional Indemity Dental Insurance
 
These plans were the original dental benefit plans that have provided good dental coverage for decades. This is the best of all 3 plans which enables patients to choose their own dentist.
 

Professional or Preferred Provider Organization (PPO)
 
These organizations provide dentistry through contracted dentists who agree to accept lower fees. Patients have more freedom of choice than with an HMO, but pay more for care from a non-preferred dentist.
 
 

Health Maintenance Organization (HMO)
 
Minimum dentistry is provided through contracted dentists who agree to small monthly payments for each employee/patient regardless if services are performed or not. Patients must see dentists on an insurance list.
 
 
 
 

We accept all indemnity dental insurance plans and PPO dental insurance plans. Although we are not signed-up as a preferred provider for PPO plans, benefits will be paid at a slightly reduced fee.

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The information contained within this web site is for the sole purpose of identifying dental care or treatment and to inform our patients about our practice. This web site does not offer any  form of dental or medical advice. Neil A Priske,D.D.S. does not represent, warrant, or guarantte that any specific treatment is appropriate to your present or future dental needs. Please contact a dentist or hospital if you are experiencing dental pain or have a dental emergency. The rights to the names of products or services mentioned are the property of their respective registered trademark owners.

2050 Montrose Ave., Montrose, CA. 91020
(818)249-6133 doctor_priske@yahoo.com

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