Dental Insurance FAQS
North Raleigh Dentist
How does dental insurance work?
Dental Insurance functions differently than traditional medical insurance. It’s often best to think of dental insurance more like a gift card as most plans cap out their coverage at $1500 or some other fixed amount. Unfortunately, these annual maximums have not changed much in the last few decades and we’re seeing premiums (what you pay per month for the insurance) increasing. For most insurances, we can contact the insurance company and get an estimate for how much they will pay for your dental care. Then we can collect from you only the amount you owe personally (also known as your co-pay). If you have Delta Dental, we may ask for payment in full as Delta Dental sends the insurance coverage check directly to the patient about 7-10 days after we file the claim. This saves our patients from having to mail a check or come back to our office to pay your balance. If you are ever concerned about your co-pay or the cost of treatment, please let us know. We have options to ensure you don’t have to choose between your oral health and personal financial constraints.
Which dental insurance plans do you take?
We accept all commercial dental plans that allow you to choose any dentist, not just the dentists they have a contract with. Unfortunately, this means we can not accept DMO plans. We are proud that we don’t contract with any insurance companies as those contracts would limit or restrict what we can offer our patients. We do this so that we can focus on patient-doctor dictated treatment, providing the best treatment possible for our patients, not what’s best for an insurance company. This ensures that we can set aside ample time with our patients, utilize the best labs and highest quality materials, and provide exceptionally comfortable patient care. Most insurance plans will allow their members to choose their own dentist, but if you have any questions or concerns, let us know and we’ll work with you to sort it out.
My employer offers dental insurance, which one is going to be the best for me?
First, we strongly advocate for picking a plan that lets you choose your own dentist with the least amount of restrictions.
Second, it is important to find out if the plan offered will cover treatment costs based on the average fees for where you live or for a maximum contract fee that they pick. This is important because a cleaning normally costs around $115 in Raleigh. But some insurers will tell you that they pay 100% of your treatment cost, but don’t reveal that the 100% is only up to their contract amount of $60. That would leave you with a co-pay of $55.
Lastly, it is much easier for patients when their insurance will pay the dental office directly for the covered part of treatment. This is called assignment of benefits. As we mentioned in the question above, Delta Dental often sends payment to the patient, requiring us to collect full payment directly from the patient. Most plans will send payment to our office directly, but it is always good to check.
If your options offered by your employer do not meet these three criteria, you may want to speak with your employer about other options that they might be able to provide in the future.
My employer does not offer dental insurance, what can I do?
While there are dental insurance plans available to purchase on the open market, they usually do not make good financial sense. Without the cost subsidy from an employer, the premiums are so high and restrictions more difficult, that patients don’t recoup the money they’re spending each year on the policy.
We created an In-house Membership Plan to to address this challenge for our patients who don’t have access to an employer sponsored plan. Our membership plan is structured to not only recoup your monthly cost in dental services, but offer you a discount for committing to come in for your regular preventive dental care. You can sign up for the membership plan on our website, calling our office, or by coming in to see us.