You can see a dentist even if you do not have dental insurance. The dentist will still bill the same insurance codes as if you had insurance, but you, the patient, will pay them directly.
We Care Dental Care offers a $99 new patient special that includes your exam and all needed x-rays on the first visit. After this appointment, we will give you a comprehensive treatment plan, which will include any additional required treatment to help you reach your oral health goals.
In addition to our $99 new patient special, we have an in-office discount plan that includes almost all preventive (cleanings) and diagnostic (x-rays and exams) treatments. This plan also includes a discount for other restorative dental services such as fillings, crowns, and dentures. Please give the office a call at 540-427-7274 to learn more about our in-office discount plan.
This will depend greatly on the discount plan and the insurance policy. For example, the in-office discount plan at our office has no maximum or waiting period. Many dental insurance plans will make you wait months and months to access your full benefits.
Most dental insurance plans have an annual maximum benefit of around $1,500. This means that any services needed above that amount will not be paid for by the insurance and will need to be paid for by the patient.
Another important fact to consider is that this $1,500 is not like a bank account you can use to directly pay for treatment. The insurance company pays a specific amount for different procedures, and any additional amount is paid by the patient as a co-pay. Any unused insurance benefits go away at the end of the year.
Typically, you can use your dental insurance if your dentist is out of network. Your dentist will have set a fee for their services, and the insurance company will cover a percentage of a lower fee. This can be confusing for patients because their plan might say they pay 100% for a service, but that is 100% of a lower fee.
For example, a cleaning and exam are $100, and your insurance covers “100%” of it, but the agreed fee is $70. This means that the insurance company will pay $70, and the patient will need to pay the remaining $30. If the dentist was in-network, that $30 would be adjusted off and not charged to the patient.
Some plans have NO out-of-network benefits. If the dentist is not in-network, your insurance will pay nothing. Many private insurance companies are not like this and have out-of-network benefits, but government-funded programs such as Medicaid typically have no out-of-network benefits.
For many dentists, being in-network is an effective way to attract new patients. This is because the out-of-pocket expenses for the patient are less, and the dentist's name will show up on a list of in-network providers. Being in-network for a dentist is basically a form of marketing.
If a dentist is very busy or has other methods of attracting patients, they might not feel the need to be in-network. Another reason a dentist might not be in-network with a specific plan is that the insurance may not pay enough to cover the overhead for the treatment. A dentist might choose to accept a few plans like this to help support their local community, but treating too many patients that cost practice money is not sustainable