Dental Insurance and Your Second Opinion

Many patients feel the need to get a second opinion and that is good. Here are some things for you to know before you head to your 2^nd opinion.

1.     Dental Insurance Providers: If you are seeing a dentist who is contracted with your insurance, the insurance company determines the fee that can be charged for each procedure. “That means that the fees will only be different if materials or procedures recommended are changed,” says Dr.Denine Rice from her Riverside California Periodontal practice. “If the treatment and products are identical, there should be no difference in the fees.”

2.     According to most dental insurance contracts with dentists, the dentist is not supposed to waive a patient’s copay. This could be considered insurance fraud and while it may seem nice, if the dentist is investigated, the patient with knowledge of what was done, could also be charged.

3.     Your dental office is considered a third party. The contract you have with your insurance company is between you and your insurance. While your dentist will assist you by filing claims and calling to check eligibility, they have limited access to information. “If we are contracted with an insurance, they will give us a fee schedule to use and ask that we submit claims for patients, but they do not guarantee any benefits,” adds Lydia, the insurance coordinator at Rice Periodontics. “That’s why, as a patient, it is in your best interest to contact your insurance company to learn more about your dental benefits.”