HEALTH
Consumer
How to
CHOOSE A
DENTIST
— What is dental insurance and how does it work?
Important
Points…
■ Check the dentist’s good
standing with local, state and
national dental associations &
dental boards.
■ On-time offices value the
patients time as much as they
value their own. Know that low
cost clinics may double book
appointments to help defray
cancellation rates.
■ Consider office location and
convenience.
■ State of the art equipment,
although it might increase basic
costs slightly, is a good sign of a
conscientious dentist office.
Determine the dentist/staff’s
ability to show examples of
quality dentistry or satisfied
patients.
■
■ Seek referrals from other
friends/patients who have had
good experiences.
■ All quality medical care
offices have a courteous and
knowledgeable staff.
■ Check out the office insur-
ance participation and or if
financing is available.
■ All dentistry should meet or
exceed American Dental Assoc.
standards of care.
■ Cleanliness is a good sign of
a well managed and safe office.
2 HOW TO GUIDE
D
ental insurance is a highly com-
plex area that creates confusion
for many dental patients. The
complexities of dental insurance and the
lack of sufficient information provided by
some insurance companies make it almost
impossible for some patients to properly
understand their benefits. Even more con-
fusing is understanding how to properly
work with your dental insurance company
to achieve the highest level of benefits to
which you are entitled.
Dental insurance is a contract between
your employer and a dental insurance
company. The benefits that you will
receive are based on the terms of the con-
tract that were negotiated between your
employer and the dental insurance compa-
ny and not your dental office. The goal of
most dental insurance policies is to pro-
vide only basic care for specific dental
services. The services selected are based
on the cost of the policy to your employer
and the negotiated arrangements with the
dental insurance company.
Because the benefits you currently have
are decided between your employer and
the insurance company, many services are
not covered. The selection of non-cov-
ered services is not based on what you
need or want, but is based strictly on the
contract with the insurance company.
The reimbursement mechanism from
your dental insurance company is merely
a mathematical formula as to which bene-
fits you will receive and the percentage of
the dentist’s office fee that will be paid.
We do not want to compromise your care
based on restraints placed by an insurance
company.
Another fact that most dental patients
do not realize is that each dental insurance
plan has a dollar amount limitation each
year. Once this limit is reached, no other
services will be covered by your dental
insurance company regardless of how
essential the service may be to your dental
health.
Some services are typically not covered
by dental insurance companies. These
include: cosmetic dentistry, implants,
occlusion or bite redesign and other serv-
ices. Although these are important dental
services that can greatly enhance the qual-
ity of life of patients, dental insurance
companies do not feel that they should
have to pay for these services. That is why
these services are rarely included in con-
tracts with your employer.
Another fact
that most dental
patients do not
realize is that
each dental
insurance plan has
not unusual for insurance company
employees (non-dentists) to dictate the
type of care that is acceptable for patients
they don’t even know.
It is true that managed care plans help
reduce the cost of health insurance to
employers. However, once in a plan,
patients find that these managed care
insurance plans severely limit their choice
of dentists.
In a traditional dentist-patient relation-
ship, a patient selects a dentist based on
reputation and need. The patient is then
treated by the dentist and makes a deci-
sion whether or not to stay with the prac-
tice. Typically, the practice handles the
responsibility of submitting insurance
forms to the insurance company and
patients are responsible for the amount
not covered by the insurer.
HOW MANAGED CARE
WORKS
a dollar amount
limitation each year.
ARE YOU LOSING YOUR
RIGHT TO CHOOSE?
Unfortunately, today many patients are
losing the right to choose their own den-
tist. The reason is that their employers
have opted for inexpensive dental plans
that force patients to see certain dentists.
For many people, the traditional relation-
ship between dentist and patient has dis-
appeared. Patients are forced to see den-
tists they do not know simply because
they participate in a particular plan. This
new system is know as “managed care.”
Managed care essentially forces
patients to see dentists who have agreed to
accept lower fees in exchange for their
services. It is changing the relationship
between dentists and insurance compa-
nies. Instead of subsidizing the care of
patients, dental insurance providers are
now dictating who patients will see and
what type of care they will receive. It is
In a managed care system, the overall
concern is for the bottom line. The insur-
ance company contracts with certain den-
tists and closely controls the costs of the
work these dentists perform. (Some man-
aged care plans actually have penalties for
dentists who refer patients to specialists or
who perform too many procedures!)
The concept behind managed care is
“cost containment.” Certainly, by encour-
aging doctors to not perform costly proce-
dures or to not refer patients to specialists,
overall costs are reduced. However, the
focus has shifted from the patient’s well
being to the bottom line, and patients lose
the freedom to choose their dental care.
If you join a managed care plan, the
dentist you are assigned or select from the
plan’s list will be your primary dentist.
No matter what your dental problem may
be at any given time, you will always have
to see your primary care dentist before
you visit a specialist. It is the responsibil-
ity of this primary dentist to determine if
you require the services of a specialist,
and even then, your insurance company
may only allow you to see a specialist
who is part of the plan. Once again this
limits your freedom of choice and pre-
vents you from seeking out the most qual-
ified specialist for your situation.