Our Dental Practice stays as current as possible with dental insurance. Dr. Mullens’ special knowledge of dental insurance obtained as a Dental Insurance Consultant has helped us maximize our Patient’s benefits and avoid most unpleasant coverage problems.

Our Dental Practice realizes that you have either chosen or earned your dental insurance benefit, and we strongly encourage you to become as familiar as possible with your dental insurance. To that end, we hope you will find this information about dental insurance helpful:

1. Dental insurance is not like medical insurance; it is not designed to cover all patient costs.
The Patient should expect and prepare to be responsible for some unpaid dental fees, with the
possible exception of routine dental examinations and cleanings (if the proper time interval
between them, usually 6 months, is observed). The number of x-rays covered is also limited to
monthly or yearly intervals.

2. Dental insurance allows only a certain dollar amount benefit per year, often called the annual allotment.
This allotment ranges from $500.00 to $1500.00 per year, depending on the plan. Almost all plans
allow for individual allotments per family member, rather than requiring the entire family to take from
one allotment (except when they don’t).

This annual allotment does not allow discriminate use for specific services, but is applied in percentages
to the various treatments rendered. For example, a plan might only pay 50% towards a filling or crown’s
fee but would pay 100% of the cleaning fee.

Almost always, no coverage…0%... is applied to any “Cosmetic procedures”.

Some insurance plans are beginning to offer coverage on implants and implant-suppported crowns. We can determine this by obtaining a pre-treatment insurance Pre- Authorization/Pre-Determination. It should be noted that implant procedures are expensive and usually done in several separate steps over a given period of time. Each step may significanly exhaust the entire insurance plan's annual allotment for the individual.

3. Dental insurance annual allotments do not accumulate if they are not used! They are renewed each
calendar year, generally starting on January 1 and ending on December 31st. Some dental insurance plans will allow a percentage of the individual insured's unused dental benefit to carry over and supplement the following year's annual allotment, resulting in a greater total insurance benefit. We can determine this by obtaining a pre-treatment Insurance Pre-Authorization/Pre-Determination.

Some plans renew the allotment beginning in July 1 to June 31st and other cycles exist, so it becomes
important to know when the allotment is renewed, especially if expensive treatments are planned to
coincide with one insurance allotment cycle ending and another soon beginning.

4. Dental insurance annual allotments often have ‘hidden deductibles’ that are applied without warning!
Some plans take a percentage deductible the first time a plan is used, for any service provided.
For example, a dental cleaning and examination normally covered at 100% becomes less covered if a
deductible is taken out, and the Patient unexpectedly owes us a remaining balance.

We have no way of knowing if and when a deductible is taken until we receive payment form the dental
insurance company. Fortunately, if they occur, they occur only once per year, per patient.

5. All expensive dental treatment, such as crowns, bridgework, extractions, and dentures, should be
submitted to the dental insurance company for approval before starting treatment when possible.

Root canals and other emergency situations can not wait for an insurance reply, but dental insurance usually recognizes the urgency of these predicaments.
6. The submittal procedure for insurance approval for services prior to providing them is usually called
a “Pre-determination” or “Pre-authorization”, and may take 3 to 5 weeks to obtain from an insurance
company. Generally pre-treatment radiographs and narratives are required.

Unfortunately a “Pre-determination” is not a guarantee of payment, but it is the best we can do to
obtain a reasonably accurate estimate of insurance coverage and Patient responsibility.

7. This Dental Practice participates in most dental insurance plans (Delta Dental, Blue Cross/ Blue
Shield, Aetna, Guardian, MetLife, etc)… however:

a) we are probably not a member (‘we are Out-of-Network’) of any closed insurance plans such as
an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), or
‘Capitation Plan’

(i) these closed dental insurance plans usually provide a list of approved ‘Providers’ / Dentists
and quite often these ‘Providers’ are unfortunately out of our area

(ii) these closed dental insurance plans may or may not provide some benefit to enrolled patients
receiving services from us / ‘out-of-network provider’.

(iii) if they do, the benefit will be less than that provided if the patient goes to a ‘network provider’
on the approved list, but at least the Patient will be able to choose the Provider…not the
insurance company

(iv) if the Patient is unsure of our participation in his or her dental insurance, or whether the
closed insurance plan will allow some benefit to us as ‘out-of-network providers’, it is
advisable to contact the employer’s Human Resources Dept., or give us the contact
information, and allow us adequate time to research the matter before scheduling any appointments.

8. Dental insurance makes a point of placing a note on insurance coverage reports claiming that we
have exceeded their “Usual and Customary Fees” for services so they must pay less towards the
services and in result the Patient owes more. This is nonsense. Insurance companies just pay
what they will pay for a service, and that is that.
(i) Our fees are not dictated by dental insurance companies, but developed by evaluating our
office costs (overhead) and in consideration of the fees charged by other dentists in our area.

9. Dental insurance makes a point of placing a note on insurance coverage reports claiming that they
do not cover white fillings in back teeth, and have paid their normal benefit for silver-amalgam
fillings. This is nonsense. We routinely use tooth-colored fillings for both front and back teeth, and
we charge the same fee for tooth-colored fillings as we do for silver-amalgam fillings. Insurance
companies just pay what they will pay for a service, and that is that.