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When Patients Ask: Do You Participate With My Dental Insurance?

Dental insurance is complicated and confusing. Dental offices have faced complex insurance issues for years, causing many practices to move away from participating in dental plans. While this may seem scary for patients, the opposite is true. A non-restricted dental practice is simpler for both parties, and it maintains the dental insurance coverage that patients need.

Why a Non-Restricted Dental Practice is the Way to Go

The trend among small dental practices that focus on high-quality patient care is moving toward a “non-restricted” model of working with insurance companies. Instead of participating in a preferred provider network – which often limits services that can be offered to patients – offices can instead provide the necessary care patients need, and then assist patients in filing claims with their insurance companies. While it may sound intimidating at first, it’s an efficient and surprisingly simple way to give patients the proper care they require.

How Dental Insurance Works

Many patients do not realize that dental insurance is not like other insurance. Unlike medical insurance, most dental plans are not intended to protect consumers from large expenses. Instead, in most cases, dental insurance covers routine preventative care but has a relatively low cap for other procedures. Patients still pay many treatment costs out of pocket.

Dental insurance companies also have set fees for specific procedures. For this reason, participating in a dental insurance plan as a preferred provider can work for large dental groups, but it is harder for smaller, patient-oriented practices that need the flexibility of setting fees as determined by the level of care provided. In-network practices require heavy patient loads to make profits in their practices, often resulting in rushed, inferior care.

Lastly, many patients are not aware that most insurance companies let them choose their own dentist, even if he or she is out of their network.

How the Non-Restricted Insurance Model Works

Participating in a dental insurance network often limits the quality of care provided to patients. Because of this, many small practices are opting to treat patients as out-of-network providers using the “non-restricted model.” It’s important to note, however, that this does not suggest that procedures in these practices are not covered by insurance – far from it! Seeing a non-restricted provider just means that the process is a little different.

Patients working with a non-restricted provider are billed for their procedures up front and then file a claim with their insurance company with help from their dentist’s office. In most instances, they are reimbursed at – or very close to – the same level of coverage they would receive when seeing an in-network dentist.  And most importantly, patients do not sacrifice convenience or quality of care. In many cases, seeing an in-network dentist requires traveling to an area with larger dental groups. It can also mean being denied coverage for certain necessary procedures. In a non-restricted practice, the focus is on providing patients with the care they need and then helping them get reimbursed for their treatment.

Dental Insurance Claims: Easier Than You Think

The non-restricted model may seem daunting at first, but most patients are pleasantly surprised by the convenience of this model and by the level of reimbursement they receive. Here is how it works in offices like ours:

  1. You and your dentist decide upon your treatment plan.
  2. The treatment plan is sent to your insurance provider to get an exact quote that will detail how much your insurance will reimburse you for the procedure.
  3. In about three weeks, you and the dental office receive the quote.
  4. Payment options are discussed if the reimbursement rate is below the treatment plan amount.
  5. Treatment is performed.
  6. Your dentist bills you for treatment.
  7. With help from your dentist’s administrative staff, you file a claim with your insurance provider.
  8. Your insurance company is required to pay your claim within 30 days, covering treatment at a level that is considered “reasonable and customary.”

Many patients are delighted to find that their reimbursement level often corresponds with the fee charged by their out-of-network provider. In situations where the dental work must be done immediately or patients know that they are going to receive treatment regardless of the reimbursement rates, steps 2 through 4 can be skipped. If a patient needs prompt treatment but is concerned about finances, the dental office can coach the patient on how to call their insurance company, enabling him or her to receive the exact reimbursement amount right away. Many practices would love to do this for their patients, but unfortunately, insurance companies will not provide this level of information to us.

The most important aspect of this model is that patients get the dental care they require in a timely fashion, without having procedures turned down by a restrictive in-network plan.

Dental Insurance at Canandaigua Dentistry

At Canandaigua Dentistry, your dental health is our priority. We are committed to making sure you receive the treatment you deserve. We believe that your needs – not your insurance – should not be the deciding factor in your treatment plan.

As a non-restricted provider, our office will file insurance paperwork for patients or provide assistance to those who prefer to file claims themselves. We always submit our treatment plans to insurance companies so that our patients can see their reimbursement amounts. We bill our patients on 30-day terms, and often they have already received reimbursement for their claims by the time bills are due. Our fees are based on reasonable rates for procedures as determined by our years of experience, and are very much in line with what insurance companies will cover.

Our staff is always ready to support you and answer any questions you may have. Be sure to bring your insurance information to your first appointment, and we’ll begin the claims process right away. Our patients know that we have the flexibility to give them the best possible care, and we are honored to provide it.

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