Understanding Dental Insurance

Lake Oswego Dentist Serving Portland, & Nearby West Linn, OR

Dental insurance was first introduced in the late 1960's to early 1970's. It was originally introduced as a way for employees to receive tax free benefits. Total annual benefits were usually limited to $1,000. Now, 40 years later, most plans have the same annual maximum limit. And yet, as with all things, premium costs and the cost of providing dental care have skyrocketed. One cost controlling measure on the part of dental benefit providers has been to increase restrictions and limitations. The most common cost cutting measure is to contract with a particular dentist who agrees to provide care at a lesser fee.

Our office does not contract with any insurance company. If we were to do that we would be forced to cut costs by working with cheaper labs (some dentists have their crowns fabricated in China using a variety of questionable metals), using cheaper materials and providing a lower level of service.

Our contract is with our patients, so we are considered "out of network." Although it is unethical and maybe even unlawful, insurance companies may encourage members to see an "in network" dentist to save money. Another cost cutting measure is something called the "LEAT" clause which stands for least expensive alternative treatment. This gives very broad power concerning your treatment options to a clerical person often based in another country. An example of this would be the benefit paid for composite vs. mercury fillings. Composite fillings take the dentist twice as long to place and the materials are much more costly, and yet most insurance companies will only pay the benefit they would have paid toward the cost of a mercury filling! Another rather misleading and sometimes so-called "requirement" is the pre-treatment estimate of benefits. This really is a mechanism instituted by insurance companies to delay treatment and, for a variety of reasons based on actuarial studies, ensure that the treatment never takes place. And in fact, it may be unlawful to require a pre-treatment estimate.

Our personal pet peeve is the "Usual and Customary" limitation. You are given the impression that there has actually been a survey in your area to determine an average fee for a variety of dental procedures. When in reality, we have been informed that these are random numbers chosen according to the plan your employer purchased. The point is, your dental benefits are not based on need, but on specific contract terms negotiated between your employer and the insurance company. Your dental coverage concerns should be taken up with the HR person at your place of employment.

But, let's look at the bright side of all this for those of you with dental coverage. It's certainly better than NO coverage. A thousand dollars is just that, a thousand dollars. We would also suggest you speak with your employer about something called a Health Care Savings Plan. This enables you to pay for all health related services and products from contact solution to dentistry with pre-tax dollars. Most businesses offer this benefit and, if not, might be open to the idea because administrative costs are very low.

We are not under contract with any particular insurance company. This enables us to work with the best dental laboratories in the country, utilize the most up to date supplies and equipment, stay current through continuing education studies, and staff the office adequately to serve you. We DO accept all fee for service insurance plans and we ARE your dental health advocates. We file your claims for you and provide all necessary documentation.

However, tracking benefits with a multitude of insurance companies for hundreds of patients is a daunting task. So, it has been our office policy for over a decade to request that our patients pay for their care in full at each appointment and be reimbursed directly by their policy carrier. We find that when the payment is going directly to our patients, the checks typically arrive in less than two weeks. Ironically, when we are the ones waiting for payment, it can literally take months for us to be reimbursed for the work we have done. Many people have us keep their credit card information on file so when their appointment is complete, they can grab a bottle of water and breeze right out of the office. We also notice that most of our patients are racking up mileage points with the credit cards they are using. Not a bad idea to go on a trip to show off your new smile!

If you feel you have special circumstances that would warrant different payment arrangements, please discuss this with Karen, our Office Manager. For example, we have a great plan for dental financing with Care Creditthat is often even interest free. Very rarely have we been unable to work out a payment plan that enables our patients to get the level of dental care they have chosen for themselves.

Our hope and belief is that you will find that the quality of care and level of service here in our office, more than offsets any inconvenience you might experience concerning our payment policy.

Respectfully submitted by Dr. Sue Wendling and Team.

To learn more about our payment policies or any of our neuromuscular dentistry, cosmetic dentistry, or general dentistry procedures, please call or email Wendling Cosmetic and Reconstructive Dentistry, serving Portland, Lake Oswego, and West Linn, Oregon today to set up a personal cosmetic dentistry consultation.

Portland Cosmetic Dentist

17437 Boones Ferry Road Suite 400
Lake Oswego, Oregon 97035