Wood, Spooner & Mills, Birmingham General & Cosmetic Dentists

If you have dental insurance, it is important that you understand some of the common characteristics of most dental insurance plans:

1. Dental insurance plans are a business arrangement between an insurance company and a subscriber (employer, group or individual). Reimbursement levels are based on options that have been pre-selected as part of the benefit plan, not individual patient treatment needs.

   We recommend that our patients compare what they are paying for dental insurance coverage to their actual needs to determine if the cost of dental insurance is a worthwhile investment.

   • For example, if you need a dental implant or orthodontic treatment and your plan does not cover these services, you may be better off contributing to a health savings account that will reimburse actual expenses, rather than paying premiums for coverage for procedures that you don't need.

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2. Virtually all dental insurance plans are set up to pay only a portion of your dental health expenses. Dental plan maximum benefits range from $1,000 to $2,000 per year. These maximum allowances have not changed much since the 1980's. (But as we know, the cost of living has increased dramatically since the '80s).

   • Dental disease is progressive in nature, a deep cavity that needs a crown this year could require a root canal next year! It is not feasible to delay treatment for years at a time waiting on insurance benefits to ‘refresh’ each year in hopes of spreading the cost of treatment over multiple plan years.

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3. Most dental plans exclude coverage for cosmetic treatments, such as teeth whitening or veneers. (Bear in mind that ‘cosmetic’ could also mean crown or veneer coverage of darkly stained or severely chipped front teeth.) Dr. Wood, Dr. Spooner and Dr. Mills have helped many patients improve the appearance of their smile; they would never consider limiting treatment because a service is not covered by dental insurance.

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4. Every dental procedure has an associated American Dental Association® code. We submit all appropriate codes for treatment on dental claims to help our patients maximize their coverage. Dental insurance companies may use the terms “usual, customary and reasonable” (UCR) to describe fee allowances in terms of insurance reimbursement. It is important to note that these too vary by insurance company, and are often substantially different.

   • Dr. Wood, Dr. Spooner and Dr. Mills have dedicated over a thousand hours each to advanced training beyond dental school. Their mutual goal is to provide preventive treatments and long-lasting restorations that preserve the patient's total oral health. Our practice fees are based on the complexity of each procedure and time involved. In contrast, a ‘usual, customary and reasonable’ rate is based on insurance company premiums, the number of subscribers and profitability, not on the patient's treatment needs or priorities.

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5. Other insurance terminology includes ‘alternate benefits,’ ‘frequency restrictions,’ ‘waiting periods’ or ‘missing tooth clauses.’ These are designed to limit or exclude certain procedures based on insurance company determination.

   • We strive to familiarize ourselves with each patient's insurance coverage to help them anticipate out-of-pocket costs, however, we will never let any restrictions stand in the way of recommending necessary treatment.