Response To Patient Billing/Insurance Maximum Concern

Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)


Patient name
City, State  Zip

Dear _____:

Thank you for sending me your letter with your insurance payment concerns.

I see this frustrating situation occurring more and more.  Managed care is finding its way into dental insurance just as it has on the medical side.  Dental insurance coverage is simply not going as far for patients as it has in years past.

One of the secrets that insurance companies have kept very quiet is the fact that they have not raised the annual maximum benefit in many years.  When I started worked in my father’s dental office in 1976 most plans had a yearly maximum of $1,200 to 1,500; this could pay for extensive dental work, and was rarely used up.  Now it can be used up on one procedure.

When a patient is referred to a specialist for part of their dental treatment, we try to estimate what our portion of the charges will be, and find out what percentage of that procedure is a covered benefit by your plan.  We can usually estimate with pretty good accuracy, but it still leaves one factor out of our hands—the annual maximum.  We have no way to monitor what other offices have billed, and what the insurance company has paid other providers.  WDS has been a leader in electronic insurance processing and information transmittal, but it is still far from perfect.

There are literally hundreds of dental insurance plans, each with different maximums, percentages, covered procedures, and so on.  Individual insurance plans often change details every single year.  Patients need to familiarize themselves with the details of their particular plans, closely monitor their benefits, and keep us informed of their current status and any changes.  Often the patients are better at keeping us up-to-date than the insurance companies are.

I would strongly encourage you to bring up your concerns with both the insurance company and your employer.  The more people complaining of problems with coverage, the more likely it is to be improved.  I am constantly expressing my concerns to the insurance companies.  The employers need to know because they are the ones purchasing the dental insurance package for their employees.  For the most part, employers can get any kind of coverage they want for their employees.  In recent years, though, they are opting for the less costly packages, which means less inclusive dental coverage for the employees.

John, feel free to call me if you have any other questions.



Dr. _______