More Frequently Asked Questions

Q.  Are dentists affiliated with insurance companies?

No, you are their customer. Your dentist will request the estimated coverage on your policy (the % your insurance covers of a particular treatment) and calculate your out of pocket cost accordingly. Estimates are not a guarantee of payment by your insurance. Dentists cannot accurately know in advance what your insurance company will actually cover or not, until after the insurance company receives the billing information. So as the patient, you are responsible for all costs related to services rendered by your dentist not covered by your insurance carrier.

Q.  Why may I have to pay for the exam and x-ray when my policy says it covers 100% of diagnostic and preventive treatment? 

Individual policy disallowance conditions, all of which your dentist can’t know in advance of billing and is why it may be charged upfront. Such as:

  • Frequency History:  How much is allowed annually that may have been used up.
  • Deductibles:  With certain companies or policies, the deductible owed is automatically taken before the diagnostic or preventive cost allowance.
  • Fee schedule variations:  With certain companies or policies, 100% of their fee allowance is covered, which may be less than your dentists fee.
  • Exception policies of your insurance company:  For example, your insurance says they pay 100% of diagnostic and preventative. However, if you get treatment done on the same day you have the diagnostic, your insurance may deem it part of the treatment procedure fee and pay your dentist nothing for the separate diagnostic charge.

Q. Why are there any out of pocket costs (co-pays) when I have double coverage insurance?

There are some policies where 100% of costs will be covered jointly between two different insurance carriers contracted with one individual or family. However this is pretty rare, and only true if the policy is what insurance companies call “Coordinating”, where the clinic can bill the primary carrier first, then the secondary for what is not paid by the primary. Most policies are called “Non-Duplicating” where the secondary only pays after all the benefits allowed are paid by the primary insurance. Also, secondary policies often have limits on how much of certain treatments they will cover that the primary does not. Your dentist will charge as though you only have a primary carrier, but also bill your secondary just in case they cover parts the primary does not. So you will still have to pay out of pocket (co-pays) and if in the end everything gets covered, be issued a re-fund by your dentist.

Q.  Are x-rays always required before any treatment can be done on a tooth?

Answer: Yes, the dentist can only see what is above the surface of the gum line which determines part of the diagnosis. The condition of teeth below the gum line is often more important, because only with an x-ray can the doctor see if the roots are curved, close to the sinus opening, located in the nerve track, if root canals are calcified or infected, the depth of a cavity, etc. Besides, legally treatment cannot be performed without an x-ray which justifies the treatment diagnosed and performed by the dentist.

Q.  Does “Emergency Dental Care” also mean “More Expensive”?

Some clinics who profess to offer same day, or emergency type services, may be more expensive. At Emergency Dental Care, USA, we have built our practice around providing same-day appointments and treatment; in other words convenient general dentistry. You will not pay higher fees for the convenience of same-day care, in fact you will often pay less overall than at traditional clinics.

Q.  Does Emergency Dental Care accept State or Federal funded dental insurance plans? If not why?

No. Emergency Dental Care USA is a fee for service private dental provider. While it is understood people may need a reduced fee schedule for needed dental services, Emergency Dental Care USA is not enrolled with the state to provide reduced fee services. The primary reason is to pay above minimum wage for staff, afford quality materials and lab work, pay for all other related business costs, compensate experienced doctors, and provide the individual time with patients they want and deserve, it simply can’t be afforded. Some part of quality service, quality materials or both will be compromised. State or Federal dental provider compensation fees are so low it discourages providing the quality care private clinics offer. Another reason is the difficulty of billing State and Federal agencies for services rendered. Private insurance carriers have their challenges that make receiving payment difficult; but the red tape habits of government, i.e., exceptions to treatment, exemptions of treatment, pre-approval and post operative paperwork requirements, changing requirements for doctor credentialing to get properly compensated, etc. truly are a nightmare. However, don’t judge fee for service private clinics harshly, they pay high taxes (paid into the public pool) by which Government programs can be offered (taken out of the pool). The proper balance of “for profit clinics” and “Government care clinics” must be balanced in order for Government clinics to remain available to help those who need reduced fee services.

Q.  Can a tooth with an infection be extracted without antibiotics prescribed first to reduce the infection?

In most cases yes, unless the infection and resulting swelling is severe. For the safety of a person with infection and severe swelling, going to the hospital emergency room is recommended (as soon as possible) for proper monitoring and treatment to address the swelling/infection before a general dentist can perform treatment. In cases of mild infection and swelling, most often the tooth can be extracted before prescribing antibiotics. The condition of the tooth allowing bacteria into the pulp and root system are what result in infections, which can be very dangerous to the health of a patient. For this reason if the patient numbs up with local anesthetics applied, immediate extraction to remove the source of infection is advisable. In a minority of cases, the infection may inhibit local anesthetics from taking effect, in which case antibiotics are prescribed and the patient re-scheduled for treatment. In any case if you suspect an infected tooth, see your dentist as soon as possible. You don’t mess with or put off seeing a dentist for infected teeth. Infectious matter getting into your blood stream can be very dangerous to your health.

Q.  Why do general dentists sometimes refer patients to oral surgeons or other specialists.

Sometimes wisdom teeth grow in impacted (sideways) or have other conditions that require specialized instrumentation and specialized training to extract. Conditions like: Curved roots, calcified roots. proximity to the sinus or nerve tracks and other conditions revealed by the x-ray will tell your doctor a referral to a specialist is necessary.

Categorised in: Dental Insurance, Emergency Dentistry, General Dentistry, Preventive Dentistry, Restorative Dentistry