Sure. Dental insurance or insurance in general can be very confusing for most patients. Here are some things that you should know as you choose your insurance and your dentist.

• Generally, dental insurance plans are pretty good at most preventative and basic services. According to insurance, normal prophies (cleanings), fluoride treatments, sealants, x-rays, and exams are classified as basic treatments, and these are usually covered at 100%. Watch out for some plans that have low fee schedules though as these are becoming more prevalent. These plans are essentially useless to have as they do not cover even basic services and we have seen them pay as low as $5!
• Essential services usually include fillings, extractions, deep cleanings which under a standard 100/80/50 plan is covered at 80 percent. Usually, these are covered at 80% after your deductible is met.
• Advanced services including crowns, bridges, implants, dentures, partial dentures are covered at 50% after deductible.

Over the years, sadly dental insurance has quietly changed and most people are not aware of these changes. There are plenty of plans and insurances out there particularly Metlife, Humana, United Concordia which have reduced their payments so very low that their fees do not even cover material costs, let alone costs of staff and overhead and doctor fees. In addition, they have increased the burden on dentists and require specific x-rays and paperwork and even after complying with these requirements , they are increasingly denying legitimate claims.

Insurance companies have one objective – to make more profit. To this end, they are trying every trick in the book by denying and delaying claims and forcing dentists to comply with their terms. In order to be in network, dentists have to agree to take a reduced fees which is usually 50% of their standard fees and in return are promised more patients. But this is where the problem begins. No independent dentist can continue to provide services at these low rates as you will actually lose money and pretty soon need to shut down your practice.

The only way the dentist can survive is by performing more expensive procedures to keep things going and keep paying their bills. Insurance companies are trying to train the dentist to recommend cheaper and inferior products. They are trying every trick in the book to avoid paying claims and each year they come with new exclusions and requirements. All they care about is their own bottom line, not how well your teeth feel, look and function.

Here at Strive, we believe in staying true our core value and recommending treatment that is truly necessary and exactly what we would perform on our own family. We treat our patients no different. Always being ethical and being an advocate for patients’ health is our mantra and being out-of-network is the only way that we can do so.

Our out of network insurance companies do not refer us patients. We rely on internal referrals from our own patients and 5-star Google and other online reviews for new patients. We charge enough for our fillings, such that our doctors can honestly give you our recommendations without worrying about losing money if they choose the ethical option.

Our goal is your improved oral health, and we will never allow an insurance company’s fee schedule to dictate treatment. If you have more questions about your specific plan, call us and we will be happy to answer all your questions.