December is a time for reflections on the reason for the season, family, and for some, many questions about dental insurance. January resets the game table as dental coverage changes bring uncertainty and our patients, thankfully, call the office looking for advice about how to navigate the dental insurance waters in hopes they make the best choice.
What questions do they ask? I thought I’d share them!
1. Which plans are in network with Spring Valley Dental Group?
Currently, SVDG is in-network with four plans: Delta Dental, United Concordia, MetLife, and BC/BS of IL. We also accept plans that are out-of-network and will file claims for all.
2. What does it mean to me if Spring Valley Dental Group is out of my plan’s network?
A patient with an out-of-network provider will see an increase their cost. How? Their deductible will be higher and they might even have to pay more of a percentage toward the total cost of care. We believe the care delivered at SVDG is well worth the additional cost and would love an opportunity to talk specifics, so please call, 618-632-8471.
3. I see several versions of the same dental plan with different prices as my options, which do I choose?
If you’re able, choose the highest tier plan offered. The premiums are higher, but when work is needed, the coverage from a percentage perspective is worth it. For example, with the Tricare Retiree dental plans, the top tier covers cleanings and exams at 100%, fillings, root canals, periodontal work, and oral surgery at 70%, and major work such as crowns, dentures and implants are covered at 50%. Contrast that to the basic or standard dental plan. The percentage of coverage changes dramatically, 100%, 55%, and 35% respectively.
4. Asa provider, what’s your view of dental insurance?
Dental insurance is a multi-billion-dollar industry coming between you and me (your dentist). In 1969, when dental insurance became a thing, the average policy capped its annual benefits at $1500. At that time, the cost of a crown was approx. $200, and of course you could get a lot done in the course of a year with the remaining balance. Fast forward to today, despite your premiums being 10 times higher than in 1969, the average annual cap is still $1500. Except now, a single crown is now on average $1200.
As their premiums and profitability increase annually, they regularly ask your in-network dentist to cut their fees over and over again. This upcoming year (2020) dentists have braced for another drop in reimbursement rates from several insurance companies. You may notice many dental providers drop plans because of this change. Quality work, which SVDG will not sacrifice, cannot be supported with sub-rate fees. For example, SVDG schedules cleanings as an hour long preventative and instructional cleaning, with an exam. This is our standard of care that we will not sacrifice because this appointment is crucial to prevention and associated healthy outcomes. However, many offices, to accommodate the rate cuts, will cut the time of that appointment to move volume, even though care will suffer over time.
There’s a growing trend in dentistry to opt-out of handling insurance claims for patients. Dentists are being advised to take themselves out of the insurance game by charging their full fee and letting patients file insurance claims on their own, or charging full fee and having insurance companies make payments directly to their customers. Spring Valley Dental Group is not on that band wagon. We continue to serve our patients, not only with dental excellence, but also by filing, refiling, penning letters on our patients’ behalf, charging only the portion we expect insurance not to pay at time of treatment, voluntarily waiting between 10 days and 1 year for insurance payments, and then after insurance is settled then and only then do we adjust for payment in full.
Although these questions are heard often from our patients, if you are reading this blog and would like more information check out these helpful articles and blogs on dental insurance:
If you find you are looking for alternatives to dental insurance, please check out SVDG's Membership Plan. It's an in-house plan that deserves your attention.
Sincere wishes for a happy dental insurance new year!
Lance P. Martin, DMD
Spring Valley Dental Group