At Mason Elite Dentistry, you may have noticed that we are out of network with most insurance providers. Dr. Davis over the years decided that the majority of dental insurance providers did not have the patient's best interest in mind and decided to end the contracts. After buying the practice, we decided to keep the same small network and continue billing out of network. While patients are usually able to use their benefits out of network, the results vary from plan to plan. Some plans will pay the same as in network providers and some will not pay at all. We are happy to look into it for you and help you make a decision.
The biggest issue with dental benefits is that the maximum they will pay for the year is usually in the $1000-1500 range. This hasn't changed in 40 years, so $1000 of benefits would give you about $6000 of buying power in today's world. Many patients who suddenly need a root canal and crown find themselves angry, frustrated and wondering why they pay so much and receive so little. Even patients getting their regular cleanings and a few fillings may max out their coverage.
Depending on your employer, a dental plan may run about $25-$100+ a month for a plan. Over 12 months, you could easily pay for your cleanings, x-rays and exams out of pocket and come out ahead. If you did need dental work, that's where the dental insurance would help.
Keep in mind, dental insurance is a business and they have to take in more money than they are paying out to dental providers and patients. They are incentivized to deny claims, hope you don't use you benefits and ultimately keep their maximum benefit low. While this line of thinking may be a paradigm shift, it is worth keeping in mind when it's time to choose your benefits for the next year. If you are a low risk patient, you may be better off to forego dental benefits and pay of out pocket for your cleanings.
Another unfortunate part of letting your dental benefits dictate your care is that your HR department is also out to save money. They may switch their dental insurance plan carrier from year to year. We recently had a few families switch due to change in insurance. While we do understand, it makes us sad to see that factor be the most important thing when seeing a dentist. Continuity of care is a big deal in the dental world. Seeing the same patients here for decades we can attest to the wonders of conservative dentistry and our ability to "watch" certain things as opposed to jumping right into restorations. When patients jump from dentist to dentist as their insurance changes, the dental provider may be more inclined to treat the small cavity so that they will not be held responsible for not doing anything should the cavity get much bigger.
Overall, we understand how patients can be frustrated and wanted to shed some light on how it is also frustrating as dental providers. Over the years it seems insurances require more documentation, deny more claims and throw in extra hoops before paying. We hope you can see your options and how paying out of pocket isn't a bad idea when you add up your monthly premiums for the entire year. Nevertheless, we are here to help and guide you along the way if you have any questions!