Dear Patient,

In providing dental services, the question of dental insurance and how it works, continues to create much confusion and concern. In order to try and alleviate some of these questions, we provide the following explanation.

The biggest problem is in understanding exactly what dental insurance is. What it is not is insurance like your medical coverage. When you apply for your medical insurance, you must disclose any pre-existing conditions, which can dictate both your premium and what is and is not covered.

Dental insurance is not insurance at all, if you the follow the above example. It is merely a benefit provided by your employer for you to use toward your basic dental services. Coverage is not based on any pre-existing or current donations which exist in your mouth. (You were not given a dental exam prior to your employer choosing your company’s dental benefits) As a matter of fact, the amount of money provided for your dental coverage has changed very little for over 30 years! Benefits have stayed in the average range of $1,000 to $1,500 during the 30 year period, while the cost of a single crown has gone from $200 to almost $900! Benefits are not adjusted for inflations, cost of procedures, or costs incurred in providing your dental services. These adjustments are made with your medical insurance.

So knowing all this, we can now give a definition of what dental insurance really is. It is a benefit provided as “A partial reimbursement for preventative and basic restorative care”. (Linda L. Miles, CSP,CMC, Miles and Associates) Statistics show that 95% of all adult dental patients need more than basic care. Basic care usually only includes simple fillings, extractions, cleanings, metal crowns, and partial dentures. Inlays, on lays, bridges, porcelain and porcelain covered crowns are usually excluded from basic plans. This is limited by the benefit providers at their discretion.

Some providers will not allow an “alternative benefit”. This is where you submit for a procedure, say a fixed bridge to replace a missing tooth, but the provider will only provide benefits for a removable partial dentures. This benefit payment is usually a much less then if a fixed bridge were considered on its own. This is standard practice for almost all high cost dental procedures, if they are covered at all.

We hope that this brief explanation helps you better understand your dental benefits, and how they relate to your total overall dental care. We are steadfast in our resolve to help you maximize your dental benefits. We pride ourselves with providing you and your family with the best, most modern dental techniques and materials. We try to keep our costs down, so our fees remain average from this area. Your dental benefits will be considered in all treatment proposals, but treatment is based upon your needs, not the benefits your employer has agreed to. If there are any questions concerning this letter, or any other aspect of your benefits please do not hesitate to ask. Thank you for taking the time to read this and we look forward to providing your dental care.


Sincerely,
August J. Durso, Jr., D.D.S. and Staff`