IS DENTAL INSURANCE RIGHT FOR ME?

In the spirit of transparency, we are going to break down dental insurance for you…
as well as break down the overhead costs of our office.

Do we accept and work with dental insurances?

Yes we do! We bill out to all PPO dental insurances as out-of-network providers. Sometimes, patients assume this means you cannot come to our office. And luckily, that is not correct! Unlike medical insurance, going to an out-of-network provider 95% of the time does not change much for you as the patient. We still bill your insurance for you, and they still give their allotted amounts towards procedures.

Given the fact that many dental insurances have not 1) updated their allowance for patients coverage in several decades despite inflation and 2) have not updated the fees they reimburse your dentist despite inflation, you will find many dental offices resisting to comply with insurances demands. We recommend reading the information below to give you a crash-course on how dental insurance works, and what it really means to purchase a dental insurance plan. This will help you not only understand how dental insurance works, but help you make a decision if it is right for you to purchase.

The truth about dental insurance:

Dental insurance is NOT like medical insurance. In fact, it works pretty much in the opposite fashion. With medical insurance, you have a deductible to meet, then they will cover things for you without you having to worry about maxing out the policy. With dental insurance, they max you out at around $1,000 dollars of treatment for the year. Unfortunately, all that would cover for you is about 1 restorative dental service (ie-a crown) per year, and not every penny of it as many policies only cover 50% of the treatment. So let’s say you need a dental crown replaced and have a couple new cavities… your insurance benefits will max out after the crown, and you are left paying for the rest of your treatment out of pocket.

What being an “in-network provider” really means for any dental office:

For your dental office to be an in-network provider with dental insurance, the practicing dentist(s) must agree to provide services with constraints mandated by the insurance company. Commonly, insurance companies downgrade services for the patient, such as only reimbursing patients for amalgam (silver/mercury) fillings, but not biocompatible composite (tooth colored) fillings. In this case, it benefits the insurance company because they get to pay the least amount possible, but the patient gets the short end of the stick with a sub-par dental material.

Not only is optimal care a concern for Dr. Tinoco working with some insurances because he uses top of the line materials and reputable local dental laboratories, but there is a practical side as well: the financial side of operating a business. The average dental practice in California has over head at about 70-80%. For full transparency, our overhead at our office is around 87%. This is due to the face we use top of the line quality materials, use locally owned laboratories, and we choose to invest in the best equipment and technology available. Many dental offices hire part-time employees to avoid paying benefits, which allows them to off set the costs of insurance companies that the practice looses money accepting. However, we will never compromise our employees livelihood and health for an insurance companies sake. This means we provide our employees with great benefit packages and yearly staff retreats. For these reasons, it is not in the best interest of the practice as well as our patients to work with many dental insurance companies on the market.