Dentists that take insurance vs private pay dentists that submit to your insurance: Benefits of Paying Cash for Dental Care.
We get a lot of calls from people that ask “do you take such and such dental insurance at your office”. Many people are disappointed to hear that we are not an office that takes insurance up front. I wanted to speak about this and explain to people how dental insurances work. Most people assume that dental insurance works similar to health insurance. This just isn’t the case. There are many benefits of paying cash for dental care.
How Does Private Dental Insurance Work?
Private Dental insurance starts by allowing you to choose a plan based on the providers in network dentists and what you can afford to pay. If you have a dentist and they are in the providers network you can choose a less expensive plan. At the time of choosing, if you don’t have a dentist yet you can choose from any of the dentists who are in-network and choose a less expensive plan. If your dentist isn’t in the network you can still get insurance but you will pay more to see an out of network provider and you might pay more between the premium and the providers costs. The monthly premium depends on the insurance company, where you live, and which dental plan you choose. For most people this will be around $50/month which means you are paying $600/year even if you do not go to the dentist.
What do dental plans cover?
Most dental insurance plans cover 1-2 routine cleanings per year and then after that provide a discount on other dental services in the offices that accept them.
- Dental Insurance covers preventive care such as annual or semi annual cleanings
- It also covers issues related to the teeth and gums
- Not all procedures are covered – as an example cosmetic procedures such as crowns or teeth whitening
- Deductibles, co-pays, and co-insurance apply and many policies have annual coverage maximums that are low ranging from $600-$2,000
Waiting periods for Dental Insurance
Most dental policies have waiting periods ranging from 6-12 months before work can be performed. The waiting periods for major dental work can be even longer – up to 2 years. These waiting periods are put in place to guarantee that the insurance companies profit off of new accounts and to stop people from applying for insurance to cover procedures they may need at the time of their application.
Co-Insurance, Deductibles, and Co-Pays
Insurance deductibles are the minimum amount that must be paid out of pocket before the policy pays for anything. As an example, if you have a $250 deductible and the procedure is $150 the policy doesn’t pay for that and you pay that entire $150. Once the deductible is met the policy will cover a percentage of the remaining costs. The balance that is paid by the patient is called co-insurance which ranges from 20-80% of the total bill. Co-Pays are a set dollar amount and may be required at the time of a procedure. Yearly maximum out of pocket is normally higher if you pay a higher premium and lower with a lower premium. Once the maximum is hit, the patient pays 100% of remaining costs.
Dental Insurance Categories
Dental procedures that are covered by dental insurance policies are grouped into three major categories:
- Preventive dental work such as annual or semi-annual office visits for cleanings, x-rays, and sealants.
- Basic procedures such as treatment for gum disease, fillings, root canals, and extractions. These procedures have co-pays and co-insurance that determines your out of pocket expenses. Most policies cover a portion of these and the patient pays the remainder.
- Major procedures such as bridges, inlays, dentures, and crowns are covered with a high co-pay and co-insurance. This means the patient pays more out of pocket.
How Does It All Work?
An in-network dental provider will have a rate sheet that breaks down costs for each procedure they offer to the insured based on your dental plan. These rates are set and are normally accompanied with another set of guidelines of what the dentist will do for you based on your plan. For example, a dentist accepting Plan X from Insurance Company X will charge a set rate for something like a filling. This rate is set by the dentist and is on their rate sheet. For example, the cost for a filling could be $200 with your insurance. This same dentist may charge $175 for a filling for someone that doesn’t have dental insurance as they will be paying cash at the time of service which means the dentist gets paid for their work at the time of service.
Benefits of Paying Cash for Dental Care
If you pay at the time of the procedure you may pay less. This is because the dentist doesn’t have to pay administrative people to chase the $200 from your insurance company and then wait on the insurance company to send payment. It does not cost the dentist anything to get paid for their work so they can actually charge less if you pay cash. The dentist can then give you paperwork to submit to your insurance company to get reimbursed for what you paid.
Are there any other benefits of Paying Cash for Dental Care at the time of the procedure?
Yes! If you are paying cash at the time of the procedure the dentist isn’t restricted by the service and rate sheet that was agreed upon with the insurance provider. This could mean that if your insurance company suggests a root canal for a specific issue, that issue could cost you thousands for the root canal. A dentist that isn’t constrained by that service and rate sheet may be able to fix that same issue with a crown so you might pay $750 out of pocket for the crown vs a $50 co-pay, and $1700 co-insurance for the root canal to fix the very same issue.
How to choose a dentist if you are of Paying Cash for Dental Care?
Choosing a dentist based on them being in-network alone can cost you thousands more overall because of the reasons stated above. You should choose a dentist based on their merit, the convenience of their office, possibly their proximity to you, and how the dentist and your family get along. Many people are scared of the dentist as well so finding a dentist that offers treatments that are less painful such as a dentist that users lasers vs drills for many procedures can make a world of difference for you and your family.
Why choose Palm Beach Pediatric Dentistry?
Here at Palm Beach Pediatric Dentistry we are proud to offer the highest level of care to our patients. We also use the most advanced lasers on the market to keep the use of sedation techniques and the use of drills to a minimum. We accept payment at the time of service and will assist you in getting the proper forms to submit a claim to your insurance company for the services you pay for. By doing this we are able to give you the best possible care with the lowest possible pricing for your family.
Call to schedule an appointment today.
Benefits of Paying Cash for Dental Care
Boca Raton , FL 33434