At Brookdale Dental Group, we believe treatment recommendations should be based on each patient’s individual oral health needs—not solely on the limitations of an insurance plan. Dental insurance can be a helpful financial benefit, but it is important to understand that it is designed to help offset the cost of dental care and may not cover the full cost of treatment.
How Dental Insurance Works
Dental insurance is a contract between the patient, the insurance company, and often the patient’s employer. The Dental Insurance main goal is to turn a profit, it’s a business first. Each plan establishes its own rules regarding:
- Annual deductibles and maximum benefits
- Covered and non-covered procedures
- Copayments and coinsurance
- Waiting periods
- Frequency limitations
- Replacement limitations
- Alternate or “downgraded” benefits
- Required documentation and preauthorization
- In-network and out-of-network reimbursement levels
Insurance companies determine how much they will pay based on the terms of the specific plan—not necessarily on the treatment recommended by the dentist. A procedure may be medically or dentally necessary even if an insurance plan excludes it, limits it, or provides only partial coverage.
Why We Do Not Participate With Most Dental Insurance Plans
Participating, or “in-network,” dental offices agree to accept fees and contractual rules established by each insurance company. These fees may not always reflect the time, materials, technology, laboratory costs, or individualized care required to provide treatment at the standard our office believes is appropriate.
Remaining out of network with most insurance plans allows our dentists to:
- Recommend treatment based on each patient’s individual needs
- Use the materials, laboratories, and techniques we believe provide the best clinical results
- Spend the appropriate amount of time with every patient
- Avoid allowing insurance limitations to dictate treatment decisions
- Maintain the quality of care and personalized service our patients expect
Our decision not to participate with most insurance plans does not mean that patients cannot use their dental benefits in our office.
How Out-of-Network Dental Benefits Work
Many PPO dental plans include out-of-network benefits. This means you may still receive reimbursement for covered services when treatment is provided by a dentist who does not participate in your plan’s network.
The amount paid by your insurance company will depend on your specific policy. Your plan may reimburse services based on:
- A percentage of the dentist’s actual fee
- The insurance company’s allowed or “usual and customary” fee
- A separate out-of-network fee schedule
- Your remaining deductible and annual maximum
Because we are out of network, there may be a difference between our office fee and the amount recognized or paid by your insurance company. The patient is responsible for any deductible, coinsurance, non-covered services, and remaining balance.
Depending on the plan, insurance payments may be sent directly to our office or directly to the patient. Our administrative team will gladly assist with verifying available benefits, providing treatment estimates, submitting claims, and supplying documentation requested by the insurance company.
Important Insurance Disclaimer
Any benefit information provided by our office is an estimate based on information supplied by your insurance company. Verification of benefits or preauthorization is not a guarantee of payment. Final payment is determined by the insurance company only after a claim has been reviewed and processed.
Insurance policies and benefits vary widely and may change without notice. Patients are encouraged to review their plan documents or contact their insurance company directly to understand their coverage. Regardless of insurance coverage or payment, the patient or responsible party is ultimately responsible for all charges associated with treatment.
Our team is happy to help you understand and make the most of your dental benefits. However, treatment decisions should be made between you and your dentist based on your oral health—not solely on what an insurance plan may or may not cover.