Insurance Coverage Information

Facts You Should Know Regarding Your Dental Insurance!

As an optimal-care dental practice, we strongly believe our patients deserve the best possible dental services we can provide. In an effort to maintain a high quality of care, we would like to share some facts about dental insurance with you.


Your dental insurance is based upon a contract between your employer and the insurance company. Should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or insurance company directly. We will be happy to submit any necessary information, x-rays or documentation. We will always assist you in maximizing your dental benefits but you, as the patient, are ultimately responsible for making sure that you receive your full dental reimbursement.


Dental insurance benefits differ greatly from traditional medical health insurance benefits and can vary quite a bit from plan to plan. When dental insurance plans began in the early 1970’s, most plans had a yearly maximum of $1,000.00. Some 40 years later, most plans still have an annual maximum of $1,000.00. Have the premiums remained the same? Allowing for a conservative 4% yearly rate of inflation, your yearly plan maximums should be around $4,800.00. Your premiums have increased, but your benefits have not.


You may receive a letter from your insurance company stating that dental fees are higher than usual and customary (UCR), rather than saying their insurance benefits are low. An insurance company surveys a geographic area (geographic areas vary), finds the average fee and then takes 90% of that fee and considers it customary. Average has been defined as “the worst of the best” or “the best of the worst”. We do not provide average dentistry nor do we charge average fees. A survey done in the state of Washington found at least eight different UCR fee schedules for one zip code in the Seattle area.


Many plans tell their participants that they will be covered “up to 80% or up to 100%” but do not clearly specify plan fee schedule allowances, annual maximum or limitations. It is more realistic to expect dental insurance to cover 35% to 50% of major services. Remember, the amount a plan pays is determined by how much the employer paid for the plan. You get back only what your employer puts in, less the profits of the insurance company.


Many routine dental services are not covered by insurance companies. This does not mean they aren’t necessary or appropriate, just not covered.

As a courtesy, we will be happy to file your dental insurance for you and help you maximize your dental insurance benefits. We will supply the dental insurance company with any needed information such as x-rays, photos or documentation.

We do accept “insurance assignment from most insurance companies.” Please check with our insurance coordinator to make sure we accept assignment from your dental insurance.

However, we are not a Network Provider for any insurance company. We can still file your dental insurance for you but there is sometimes a difference in coverage. The amount of difference depends on the plan coverage purchased by your employer. We are always happy to file Pre-treatment Estimates to assist you in your decisions.