The cost of treatment may vary, depending on your child’s individual needs and treatment plan. We will discuss the cost of treatment and each of your available payment plan options with you before your son or daughter begins treatment, so you can make the best choice for your little one and your family.
Affordable Payment Plans
Your child’s smile can last forever, and we want to make it as easy as possible to receive the best dental care whenever needed.
We are an in-network provider for the following insurance plans:
- Aetna PPO
- Delta Dental Premier
- Delta Dental PPO
- MetLife PPO
- Cigna PPO
- Guardian PPO
- Horizon Traditional Dental Plan
- United Healthcare PPO
- United Healthcare Community Plan
- United Concordia
- ParNet Advantage
- Concordia Advantage
- Tricare Dental Program
- ELITE Plus
Dental Benefit Overview
Whether Robbinsville Pediatric Dentistry is an in-network provider with your particular insurance company or not, you can still bring your child to the office and make us your dental home! We are happy to discuss your questions or concerns about costs and coverage of dental care.
We look forward to showing you there is nothing more valuable than your son or daughter’s health and nothing we take more seriously. We know you’ll agree; the services we provide at RPD are second to none and worth every cent.
What are dental benefits and how does it all work?
Dental benefits (insurance) are a highly complex area that creates confusion for many dental patients. The complexities of dental benefits and the lack of sufficient information provided by some insurance companies make it almost impossible for some patients to understand their benefits properly.
Even more confusing is how to work with your dental insurance company to achieve the highest level of benefits to which you are entitled. We hope the following will cover some of your questions, and if not, please feel free to talk to any of our team members for answers.
What is dental insurance?
At Robbinsville Pediatric Dentistry, we refer to dental insurance as dental benefits. Dental benefits are a contract between your employer and a dental insurance company.
The benefits you will receive are based on the terms of the contract that were negotiated between your employer and the dental insurance company, and not your dental office. The goal of most dental insurance policies is to provide only basic care for specific dental services. The services selected are based on the cost of the policy to your employer and the negotiated arrangements with the dental insurance company.
The benefits you receive from the dental insurance company for your current insurance plan have nothing at all to do with you or achieving a high quality complete result.
Because the benefits you currently have are set between your employer and the insurance company, and some services may not be not covered.
This is why so many dental patients become confused about dental benefits. Dental insurance companies rarely cover 100 percent of any dental fee and, in many cases, cover less than 50 percent or nothing at all.
As an example, in the 1960s when dental coverage began, the benefit for an employee was $1,000 to $1,500 per year. At that time, an adult crown cost approximately $125, so patients were able to get most or all of their treatment covered.
Remember that in the 1960s, gas cost 19 cents a gallon, and milk was 25 cents a gallon. Today, most dental benefits still cover between $1,000 to $1,500 per year, but the average adult crown may cost between $1,200 and $1,500. (Gas and milk cost a lot more too!)
As you can see, benefits have not kept up with costs over the past 50 years.
Covered and Non-Covered Services
Unfortunately, some of the services you may need or desire will not be covered by your dental benefits. Our goal is to help you achieve and maintain optimal dental care, and that is not necessarily the goal of your dental insurance company. Its goal is to provide only the negotiated benefits for the specifically selected services.
The reimbursement mechanism from your dental insurance company is merely a mathematical formula for which benefits you will receive and the percentage of the dentist’s office fee that will be paid. We do not want to compromise your care based on restraints placed by an insurance company. In addition, it’s up to the doctor to diagnose what a patient needs and provide a treatment plan, not the dental insurance company.
Another fact most dental patients do not realize is that each dental insurance plan has a dollar amount limit for each year. Once the limit is reached, no other services will be covered by your dental insurance company, regardless of how essential the service might be to your dental health.
How Our Office Helps
Robbinsville Pediatric Dentistry will do everything possible to help you understand and make the most of your dental benefits. Our office will work with you and your insurance company to achieve the maximum reimbursement to which you are entitled, and will seek diligently to make this happen as quickly as possible.
Please be aware that some dental insurance companies take longer than others to complete payment. If necessary, our office will contact the dental insurance company, or we may request your help in this matter.
Since you or your company is paying the benefit premium, the company may respond to your request more quickly than a request from a dental practice.
Many insurance companies try to control the amount of dentistry you receive by requiring authorization for procedures in advance. Our office will do everything possible to help you maximize the insurance benefits to which you are entitled.
There is a significant difference between pre-determination and pre-authorization. Pre-determinations DO NOT obligate a benefits carrier to pay what they say they will pay, so they’re not an effective tool for determining what benefits will be paid.
A Pre-Authorization is issued for certain procedures and DOES obligate a carrier to pay. Our goal is not to delay your child’s care, and we can discuss with you the best options for you and your little one.
In most cases, we can begin treatment prior to receiving an authorization from the dental insurance company. However, patients need to understand that, in the event the dental insurance company refuses to pay for treatment, you are responsible for all fees. Naturally, we always provide you with the full fees in advance so you know the exact cost of treatment.
Like you, we recognize that the predetermination process is often time-consuming and unnecessary.
Some services are typically not covered by dental insurance companies. These include cosmetic dentistry, implants, occlusion or bite redesign, and other services.
Although these are important dental services that can greatly enhance the quality of life of our patients, dental insurance companies do not feel they should have to pay for such services. That is why these services are rarely included in contracts with your employer.
Ask Us for Help Any Time
Any time you have a question about your dental benefits (insurance), please feel free to ask us. We recognize that dental benefits have become more complicated and difficult to understand with each passing year.
This is often due to the efforts of dental insurance companies to reduce costs through continual adjustments. Keep in mind that the dental insurance companies are not concerned about coverage for optimal dental care, but provide coverage for only a limited number of basic services.
Robbinsville Pediatric Dentistry remains dedicated to providing optimal care for every patient and working with you to achieve that goal. We pride ourselves on helping you in any way and in continuing to provide the quality of care to which you have become accustomed.
Please let us know if you have any questions; it will be our pleasure to help you.