For Patients / Insurance
Understanding
Dental Insurance
Dental insurance can be a helpful tool for managing some of the cost of dental care, but it’s important to understand what dental insurance is and what it isn’t.
Your Care Should Be Guided by What You Need
Your insurance company determines what it will cover based on the terms and limitations of your specific plan. Our doctors make treatment recommendations based on something different: your individual needs, your oral health, and what we believe will provide the best long-term outcome.
Those two things don’t always align.
Understanding Your Plan
Dental Insurance Has Limitations
Unlike many medical insurance plans, dental insurance typically provides a limited annual benefit toward your care. Depending on your plan, you may encounter:
01Annual maximums
Once your plan has paid its maximum benefit for the year, you are responsible for additional treatment costs.
02Frequency limitations
Your plan may limit how often it will contribute toward certain exams, X-rays, cleanings, or procedures, regardless of whether your dentist believes they are necessary.
03Waiting periods and exclusions
Some plans require you to wait before certain services are eligible for benefits or exclude particular treatments altogether.
04Downgrades and alternative benefits
Your plan may provide benefits based on a less expensive treatment option, even when you and your dentist choose a different treatment that better fits your needs.
05Network restrictions
Insurance companies often encourage patients to choose an “in-network” dentist because that dentist has agreed to the insurance company’s contracted fee schedule. Being out of network does not mean that a dental office cannot see you. Whether you can use benefits there depends on your plan.
These limitations determine what your insurance company will pay for, not necessarily what dental care is appropriate for you.
Out of Network Doesn’t Mean Out of Options
You can still be a patient at Breton Gardens even if we are out of network with your dental insurance.
One of the most common misconceptions about dental insurance is that you can only see a dentist who is “in network.”
Being out of network means we do not have a contracted fee agreement with that insurance company. It does not mean that we cannot see you or that you need to leave a dental office you know and trust simply because of network status.
Many dental plans include out-of-network benefits, which means your insurance may still contribute toward care received at our office. Some plans do not include those benefits. The amount your plan pays can vary, and there may be a difference between your insurance benefit and the cost of treatment.
Our team is happy to help you understand your benefits and provide estimates whenever possible. Ultimately, we want you to choose your dental office based on where you feel comfortable and confident in your care, not simply based on a name in an insurance directory.
Our Commitment Is to You
Insurance coverage can change from year to year, but our approach to your care does not.
Our commitment is to explain what we see, discuss your options honestly, and recommend the care we believe is appropriate for your health. We will never allow whether an insurance company covers a procedure to be the sole factor in determining the care we recommend. Insurance may help pay for treatment, but it does not determine the care you need.
Another Way to Plan for Care
Looking for an Alternative to Dental Insurance?
For patients without dental insurance, our Breton Gardens Membership Plans offer a simple and transparent way to stay consistent with preventive care while receiving savings on additional treatment.
- No deductibles
- No annual maximums
- No waiting periods
- No insurance claims
Questions About Your Benefits?
Dental insurance can be confusing, and every plan is different. If you have questions about using your benefits at Breton Gardens Family Dentistry, our team is happy to help.
