Insurance & Financing
Affordable Dental Care
Many patients are fortunate to receive benefit packages from their employer. Often these “perks” include dental insurance. Important things to know about dental insurance regarding our office:
- We accept dental insurance plans
- However, you don’t have to have dental insurance to be seen in our office
- We are in network with many dental insurance plans, including Delta Dental and Blue Cross. Please call our office at 620-663-9133 for more information about your specific plan.
Our primary mission is to deliver the finest and most comprehensive dental care available. An important part of the mission is making the cost of optimal care as easy and manageable for our patients as possible by offering several payment options.
You can choose from the following options:
- Cash, Check, Visa, Mastercard, or Discover Card.
- Payment Plans from CareCredit.
- We also offer a senior discount to anyone over 65
FAQs About Dental Insurance
Q. I don’t have dental insurance. Is there any good option for me?
A. Many of our patients are surprised to find out how affordable their dental care is, even without insurance. Many times, they end up spending less on their care than they would pay for an insurance policy. If you would like to investigate individual policies, there are plans available to purchase directly from dental insurance companies. Our front office personnel are very knowledgeable, and would be glad to answer any of your questions.
Q. Why are my dental benefits better than my spouse’s even though they are both from the same insurance company?
A. Whenever your employer buys a dental insurance policy from an insurance carrier there are several things to consider, most importantly cost. There are as many insurance policies as there are employers. The price of an insurance policy determines the level of coverage that you get. Insurance carriers sell “cafeteria” style policies allowing each employer to choose what will and won’t be covered and how much to pay for covered procedures. In other words, “you get what you pay for”.
Q. Shouldn’t my dental insurance provide for all the dental care I need for a year?
A. Unlike medical plans, dental plans have a maximum amount that your employer will pay out per year. Sadly, the average yearly maximum has been the same for decades. There have been no increases for inflation or the rising costs of care! If you have one or more teeth that need attention, it is unlikely that $1500 will cover all needed expenses. Your dental insurance is meant to help off-set some of the cost for your care but is not meant to cover all care even in the best of circumstances. Consider today’s dental plans as a coupon for $1500 with multiple conditions for redemption and an expiration date.
Q. I need a cleaning four times a year but my insurance company will only pay for two. Shouldn’t the insurance company pay since it is “clinically necessary” for me?
A. Another way for employers to limit their costs associated with dental benefits is to set up rules for how often procedures are to be paid. Common examples of frequency limitations include: One cleaning every six months and x-rays once a year. Dental policies are not governed with the “clinically necessary” model used in medical policies but by the framework rules (frequency, quantity, reimbursement levels) set by the employer when the policy was purchased. These money-minded restrictions are not meant to sway the patient away from needed services, but to simply limit the employer’s financial responsibility.
Q. How does my insurance company determine how much to pay on my dental claims?
A. The price of the policy was calculated based on the “ceiling amount” the carrier would pay for each procedure. The term that insurance carriers use for this is UCR or Usual, Customary, and Reasonable. UCR is actually not one fee per procedure but a statistically gathered table of fees set up at percentile levels from 20-95% for each zip code in the United States. Almost all dentists set their fees at the 90-95th percentile for their given zip code. Many policies used in a given area are also set at the 90-95th percentile for the zip code for which the policy was bought which makes the 90-95th percentile what is truly Usual, Customary, and Reasonable for a zip code. However, the employer chooses the level (sometimes lower than 90th percentile) to set the dental policy just as maximums, frequencies, and covered procedures are chosen during the cafeteria style process. A “better” dental policy will have a more inclusive, higher percentile-paying policy resulting in less money coming from the patient’s pocket.
Q. I know all insurance policies are different but how do I know if mine is worth the money?
A. A typical policy will normally pay at the following percentages of the Employer’s Maximum Benefit Fee (not the dentist’s actual fees): 100% (exams, x-rays, cleaning, fluoride, sealants); 80% (silver fillings, root canals, deep cleanings, extractions); 50% (crowns, bridges, dentures). Currently, most policies pay about 65-70% for white fillings on back teeth due to a restriction called the Alternate Benefit Clause that many employers adopt to limit plan costs. Approximately half of dental policies have some coverage for implants and implant crowns. Most policies exclude coverage for tooth replacement if the tooth was missing before you went to work for your employer and for cosmetic work including front tooth crowns and veneers.
Q. Why does my insurance not pay for all of my cleaning visit even though it says it pays at 100%?
A. The 100% clause in your policy relates to 100% of the charge that your employer chose when the policy was bought rather than the dentist’s actual fee (which is generally set at the 90-95% percentile level explained above). The fine print in your dental policy will always read 100% of the “Maximum Allowable Charge as Outlined in the Plan Benefit Booklet”. An employer can choose to lower the cost of a dental policy by choosing a lower percentile such as 70 or 80%. The difference between what the insurance will pay on the employer’s behalf and the dentist’s charge would be the patient’s responsibility rather than the employer’s thus lowering the employer’s benefit plan costs.
Q. My employer has several different dental benefit options. What is the difference between a PPO, a DMO, and an indemnity policy?
A. There are 3 types of employer provided insurance: PPO, DMO, and indemnity. A Preferred Provider Organization (often referred to as a PPO or PDP) is a type of insurance that gives patients a choice as to where to have dental care. A patient may chose from the PPO list to find a provider that has a contract with the insurance company or go to any dentist he or she chooses. The insurance policy rules and level of reimbursement are usually the same whether you use a network provider or not. The advantage is that the provider’s fees are set by the PPO insurance contract at a lower level and therefore the patient’s copays may be slightly smaller.
A DMO or Dental Maintenance Organization is not a true insurance but a system where a patient is assigned to a dental clinic near the patient’s home or work. The patient is required to use that dental provider and in return receives dental care for copays or at prearranged discounts. No claims are filed. If the patient needs to see a specialist, the assigned dentist determines necessity and gives a referral to a contracted specialist. The model is very similar to the HMO model except that there are few dental providers that contract with Dental Maintenance Organizations because the fees that insurance companies set for participating dentists are lower than the actual cost of the care. Therefore a patient’s access to care is often reduced resulting in frustration and loss of use of the dental policy.
An Indemnity policy is similar to a PPO policy except that there is no network with which to contract. The patient chooses a dental provider and the insurance company pays based on the rules set up for the policy.