Insurance Information

At Topsham Dental Arts we believe that you deserve the best care. That is why we always present you with the optimal dental solutions possible to treat your individual circumstances. Each year we provide care for hundreds of patients, some have dental benefits and some do not. If you have dental benefits here are some important things you should know.

Your dental benefits are based upon a contract made between your employer and an insurance company. If you have any questions regarding your dental benefits please contact your employer or insurance company directly.

Dental benefits differ greatly from medical benefits. In 1959, most dental benefit plans had a yearly maximum cap of $1,000. You will be surprised to know that today the average dental benefit maximum cap is $1,000. There has been no significant increase in the yearly maximum cap in over 40 years! However, there have been significant increases in your premiums. Dental benefit plans will never pay for completion of your dental care. It is only meant to assist you.

We currently accept all private care insurance plans (plans that do not require you to select a dentist from a list or require our office to accept a reduced fee for service). This means that we work with literally thousands of companies. Although we can maintain computerized histories of payment by a given company, they do change; therefore it is impossible to give you a guaranteed quote at the time of service. We estimate your portion based on the most up-to-date information that we have, but it is only an estimate. If you would like to know your exact insurance benefit, we will be happy to file a "pre-treatment authorization" with your insurance company prior to treatment. This does delay treatment but will give you the exact amount of your personal investment.

Many people receive notification from their insurance company that dental fees are "above usual and customary." An insurance company determines their reimbursement level by surveying a geographical area, calculating the average fee, and then determines that 80% of the average fee is customary. Included in this survey are discounted dental clinics and managed care facilities, which have severely reduced fees that bring down the average. Any doctor in private practice will have fees that insurance companies define as "higher than usual and customary."

We bill your insurance as a courtesy. If insurance does not pay within 30 days, Topsham Dental Arts reserves the right to request payment in full for services from you and let you collect the insurance funds that are due you. This is rare, but it is important for you to recognize that the insurance you have is a legal contract between you and your insurance company. Our office is not, and cannot be part of that legal contract. Ultimately, you are responsible for all charges incurred in our office.