The two most common questions we get from our patients are:

1. Do you take my dental insurance?
2. How much my insurance will pay and how much will I have to pay?

The short answers are:

1. Give us your insurance information before the appointment and we will check.
2. We can only give you an estimate, but it will be no more than our office fees.

TLTR version:

It is important to understand that dental insurance works differently than medical insurance. Medical insurance is meant to protect you from unexpected large medical expenses. It usually covers one preventive visit per year, then you pay a deductible and copay for minor health issues and once you reach a certain out of pocket maximum, they will pay for your major medical expenses for the rest of the year.

Dental insurance is more of an incentive from an employer to help their employees to take care of the teeth, so they look presentable at work. You get a limited amount per year (usually $1000-2000) and a certain percentage of coverage for each category of dental services (typically preventive 100%, basic 80% and major 50%). Once you reach a yearly maximum, dental insurance does not pay for any services until next benefit year.

Dental insurances come up with different categories of plans and pricing. It is up to your employer or you to purchase a more expensive plan with a larger annual maximum, higher percentages and out of network coverage, or to save money by adding a waiting period, excluding many services, or even limiting coverage to one specific clinic.

Patients also ask us if they should purchase an individual dental plan. For patients, who need a lot of dental work, it might make sense, however, there are even more limitations and fine print. Remember, the insurance companies are not charitable organizations that want to pay for your dental treatment. They turn large profits and pay millions of dollars in salaries to their top executives. For them it is all about risk management. When a large employer purchases a dental plan some of his employees have good teeth, some finished expensive dental work last year and some are afraid to go to a dentist, so the risks are spread out. If an individual purchases dental coverage there is a good chance that they will use it to the maximum, so insurance companies put a lot of limitations on coverage and will take all their money back if you cancel before the end of 12 months. Be aware that insurance agents selling those plans are paid on commissions and they might not understand dental insurance well enough.  

To add even more complexity, insurance companies could place dentists in different categories and assign different coverage.  For example, Delta Dental has PPO, Premier and Out of network providers. Some plans will keep the same coverage for all three categories, some will cover PPO and Premier the same, some will only pay for PPO providers, and some will reduce maximum and allowed percentages for Premier and out of network. Those details are in the fine print, and we have no access to the contract between the employers and Delta Dental.

If that is not enough, besides major insurance companies (Delta Dental, Premera, Regence, Aetna, Cigna, MetLife, Guardian, Principal, Ameritas, Careington, United Healthcare…) that are a bit easier to figure out coverage for, there are many small insurance companies and employer sponsored plans that lease fee schedules and networks from larger insurance companies. We have absolutely no way to determine their coverage. They may tell you that preventive is covered at 100%, but what they did not mention is that it is 100% of their fee schedule and no one in town has agreed to accept their fee schedule that pays $30 per dental cleaning. Some insurance companies share networks or have umbrella networks. For example, we are in network with Aetna and that automatically puts us in network with Principal, Ameritas, United Concordia and some other insurance companies. Those alliances and agreements also change constantly.

At Birch Dentistry we still accept most dental insurance plans provided by an employer or purchased individually. We are always happy to check your coverage. If you have a choice when purchasing dental coverage, please consider selecting a plan that covers out of network providers. Most specialists and many dentists in our area got out of network with dental insurance companies.  The Greater Seattle area is one of the most expensive in the country when it comes to rent, labor and supply cost. Insurance companies have not increased their contractual fees for years and some even reduced them, so more and more dentists are refusing to join networks with fee schedules that are below the cost of providing dental care.  

Insurance companies have become increasingly difficult to work with. They impose a massive administrative burden on dental practices who often need to do battle with them to get paid for even the most routine claims. They delay payments by asking for additional information repeatedly and accidentally losing claims. Now treatment necessity is determined by AI, claims are processed by computers, it takes hours to get customer service representative on a phone and some insurance companies simply do not have customer service to call.

We are still in network with Aetna, Delta Dental, Premera and Regence and out-of-network with other dental insurance companies. We submit claims to all dental insurances on our patients' behalf and work with them to maximize patient benefits. We've found that in many cases out-of-network coverage is as good as in-network coverage. Please don't assume that your costs will increase if you see a dentist out-of-network.

We do not accept Medicare, Medicaid and Apple Health insurance. ICHS, Sea Mar, King County Public Health, NeighborCare and University of Washington Dental School are some of the clinics that operate on state and federal grants and provide dental care for the patients covered under those insurance plans. Sometimes additional coverage could be purchased that would allow Medicare patients to use any dental provider in the area.  

In addition, we offer an in-office membership plan for our patients to ensure that excellent care is still affordable. With our in-office Rodina discount plan there are no claims to file, no waiting periods, and no denial of services.

We love creating an environment for our patients who appreciate the quality of care they receive and the state-of-the-art technology we use. Our commitment is to treat you as we would treat a family member with individual care and attention. This commitment will never change, regardless of what insurances come into play.