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  • Writer's pictureDr. Peter - Pediatric Dentist in Arlington, Virginia

Dental Insurance Myths; Pediatric Dental Pearls

1. My insurance should pay for all my care

In reality: Insurance is meant to help cover some of the costs of dental care. Very rarely (almost never) does insurance pay 100% for all procedures and there can be large differences in the benefits provided. These differences are usually based on the contract your employer has selected with the insurance company.

In the 1960’s yearly insurance maximums were $1,000-1,500. Today many plans still have these same maximums. In the 1960’s, a Ford Mustang was $2500. Adjusted for inflation these maximums should be around $10,000-$12,000 in today’s dollars.

2. If I have two insurances, I should not have any remaining balance for treatment

In reality: Most of the time you will still have a balance for treatment. Although having an additional plan can be beneficial (sometimes), treatments may not be covered by either insurance company properly. Additionally the secondary insurance may not make any additional payment if the primary insurance has paid more than the secondary insurance’s “usual and customary fees.”

3. Insurance company benefits and limitations are in place to help guide me to what procedures are necessary and which are not.

In Reality: Benefits and limitations are set by each insurance company and may have no relationship to what is necessary and what is not. For example, many insurance companies have age restrictions for sealants, frequency limitations for radiographs (x-rays) and fluoride, and many do not cover nitrous oxide (laughing gas). Science, clinical experience, and research have proven many of these treatments to be beneficial and necessary but if insurances can get away with not paying for them...

4. Insurance companies’ usual and customary fees are an accurate representation of what dentists should be charging.

In reality: “Usual and customary” is a term coined by insurance companies and has no relationship whatsoever to what is truly usual and customary. It is a misleading term that has resulted in customers feeling they are being overcharged when in fact the dental insurance company is underpaying or provides poor benefits. “Usual and customary” fees can vary greatly with different insurance companies. If the fees were actually usual and customary, shouldn’t they be similar between the different companies and plans? Generally speaking, a plan that is less costly to the employer will usually have a lower usual and customary fee schedule. is a website that has been available for years that allows you to search a dental code and see what the 'average' cost is in your area. Quite a few plans will claim to pay 'UCR' but pay 1/3rd to 1/2 of the 'average' cost.

5. The dental office has to work with me to get better benefits

In Reality: Although many offices will file your insurance as a courtesy, none are under any obligation to do so. Insurance companies are under no obligation to take our phone calls, provide correct information, and are increasingly difficult to get in touch with. We spend on average 30-40 minutes per patient to verify and get breakdowns before each appointment. Additionally, insurance companies will only pay what they are going to pay based on the plan’s benefits and limitations.

6. A dentist who is a “preferred provider” has been vetted by the insurance company to be a better dentist, clinically and ethically

In reality: “Preferred provider” is a misleading term created by insurance companies. It does not mean the dentist is in any way better than a non-preferred provider. It only means that the provider has chosen to join the insurance company’s network (and often takes a substantial 'discount' to their fees in an attempt to get more patients in the door).

Finally and most importantly:

7. The insurance company cares about my health

In reality: Insurance companies are in business to make a profit. They are not in the healthcare business. They care no more about your health than your auto insurance cares about the health of your car.

Schedule An Appointment Today in Arlington, Virginia at VK Pediatric Dentistry

If you haven't taken your child to a pediatric dentist yet or would like to schedule an appointment, Dr. Peter and the highly skilled team at VK Pediatric Dentistry are just a phone call away. Schedule an appointment online or call us today at 703-962-7814. We look forward to providing your children with a lifetime of healthy and happy smiles!


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