I recently got a request to write a blog about finances! My head almost immediately started to spin. Not personal finances, although that topic might have been an easier sell, but instead a blog about insurance, deductibles, and financing dental work.

I know, right? Before you run for the hills and scroll onto the next post in your Facebook feed or click over to Pinterest, hear me out. I’ll try to make this painless as possible.

Now, before we dive into it, let me warn you: this pool is pretty deep and the water can be cold. It’s a really complicated topic, and it’s one that I don’t consider myself an expert on, even as a Dentist.

Sure, I know more about it than the average person, but it’s a tough concept to wrap your head around and fully comprehend. In order to do this topic justice, I conferred with my trusty sidekick Nicki, better known in our office as Insurance Gal, on some of the tougher concepts.

Don’t worry, everybody, we can do this. We’ll get through it together!

How Does Dental Insurance Work?

The first thing you need to know about dental insurance is that it does not operate in the same way as medical insurance. What do I mean by that?

Well, in medical insurance, once you reach your annual deductible, you’ve typically got it made in the shade. All of your expenses are covered. While every dental insurance plan is different, you typically have a relatively low deductible to “activate” your coverage. Once you’ve paid that amount, your insurance plan will help offset any costs over that. The big difference here is that the real value in dental insurance is to reduce your financial burden, not eliminate it.

I know…if only, right?

Dental Insurance as a Pool

Now, I need to unpack that concept a little bit here. We ”participate” with a bunch of different insurances for your benefit. By doing that, we agree to reduce our practice fees to match the insurance’s negotiated fees.

So dental insurance, like medical insurance, serves as an intermediary to help make the cost of oral health care more affordable to you. If we continue with the pool analogy, think of a community pool.

In Charlottesville, the Parks and Recreation department operates a number of different pools. All the pools obviously cost money to operate (lifeguards, chlorine, maintenance , etc.), so the Parks and Rec department charges a fee to use them. However, if you are a city resident, this fee is offset since you are already paying city taxes.

Some of your taxes help subsidize the operation of the pool, just like the cost of your dental insurance premiums help subsidize the cost of your oral health care. So when we participate with your insurance, we treat you much the same as the Parks and Rec department treats city residents at the community pools. Pretty neat, huh?!

Everybody’s still with me? Both of you? Good deal, let’s keep on plugging away then.

The Bad News About Dental Insurance

Let’s get a little bit of bad news out of the way: unfortunately, dental insurance typically only covers a certain percentage of their negotiated fee. So that reduced amount that we were talking about before? They’re only going to cover some of the remaining amount. Then they pass the rest on to you. It’s a bummer.

Imagine the pool scenario again. Let’s say it costs $10 per swimmer to operate the pool. But since you’re a city resident, you’re paying $2 of your portion through your taxes (the subsidies we were talking about). When you come to the pool to swim, they only charge you $8, which is great. If the analogy were perfect, a third party would pay a part of your $8 and then you’d be responsible for the remainder.

Insurance at Children’s Dentistry of Charlottesville

Insurance at CDOC

While some offices don’t do this, we choose to do it as a courtesy to you. That’s just how we roll 🙂

But seriously, what that means is we handle the majority of the “hassle” by contacting your insurance, filling out their paperwork, and making sure they kick in their portion for you. It’s a pretty good deal, and we’re happy to do it.

People often call to ask what insurances we “take.” Here are the insurances we accept at Children’s Dentistry of Charlottesville:

*We just became participating providers with Anthem in 2017

We’ve been a committed provider for Medicaid from day one, and we will always continue to do so. Being a resource for the underprivileged and underserved is at the core of our mission. It’s what keeps me coming to the office every day.

If you have an insurance problem, let us know. We have multiple staff who are trained to assist you with your insurance questions, and can even help point you in the right direction when it comes to obtaining coverage.

If the cost is a barrier to obtaining the services you need, let us know. We’re here to help.

Why Does Dental Insurance Cost What it Does?

Finally, one of the big problems with oral health care is the “sticker shock” that patients often get when they first see the bill. While the question “Why is dental care so expensive” is a topic unto itself and is probably worthy of a full blog post, the short answer is threefold:

  • Oral health care is expensive to provide.
  • You’re not paying for our services as much as you are for our expertise.
  • Your child’s health and well-being are worth it.

Does it cost a lot? Sure, it does. But when you’re considering the cost, focus on the quality of life that you are improving by caring for your oral health. Healthy teeth and gums can affect your overall health and well-being, and that’s something that I know we all want for ourselves and for our children. Never underestimate what a big, huge smile does for you.

Any questions about anything covered here or dental insurance in general? Give Children’s Dentistry of Charlottesville a call at (434) 817-1817, contact us online, or leave a comment below.

And if you see me around at the Charlottesville Onesty Aquatic Center on Meade Avenue, come on over and give me a high five and show off that healthy smile!

Keep Smilin’


p.s. We made it through a tough subject with minimal jargon! Congrats to you for sticking with it and thanks for reading. It means a lot.