Straits Area Dental | Petoskey Dentists | Mackinaw City | Alanson

Dental Insurance

We at Straits Area Dental are proud to be one of the very few dental offices in Northern Michigan that participate with most dental insurance companies, such as:

We also accept Michigan Healthy Kids and MIChild because we support the effort of the State of Michigan to assist children with dental health.

At many dental offices, you have to pay in full at the time of treatment, and then insurance payments are sent to reimburse you. At Dr. LaTocha's office, we file your claims daily via electronic claim submission and reimbursement comes directly to us unless otherwise specified in your particular policy. You pay only your copayment at the time of treatment.

We Accept Most Insurance Policies

Our dedication to your oral health has come first and we continue to be one of the few dental office accepting most insurance policies, including PPOs. Because our office is computerized, we are able to use the fee schedules provided by the insurance companies. This makes our calculation of your copayment very accurate and reduces the chance of that you'll pay either too much or too little at the time of treatment. There are rare times when what we estimate and what the insurance carrier pays differ; however, we pride ourselves on attempting to be as accurate as possible when dealing with your insurance carrier.

Many people believe that because they have Medicaid they can only receive dental care through the health clinic. For many, Medicaid in the State of Michigan covers dental visits through the insurance company Delta Dental, including Michigan Healthy Kids and pregnant women under 19. At Straits Area Dental, we participate with Delta Dental, allowing Medicaid patients to receive care at our private practice.

History of Dental Insurance

Automobile assemblyline In the early 1970s, there were very few dental Insurance carriers. It wasn’t until the auto companies negotiated dental insurance coverage that we saw a boom in the dental insurance industry. The first policies that were written for the auto companies, the biggest employers in our state of Michigan, were wonderful. They included a $1000 insurance maximum. Can you imagine having $1000 in 1970 to assist you with your dental needs? One thousand dollars in 1970 would buy a lot — that was almost half the cost of a car and gas was only 29 cents a gallon! Most people using their dental benefits in the 70s couldn’t even use their entire maximum.

Dental Insurance Today

Sadly the insurance industry has not kept up with inflation, and most policies today still have that 1970s $1000 maximum. When adjusted for inflation, $1000 in 1970 is worth nearly $5600 today. Conversely, $1000 today was worth roughly $184 in 1970.

What's more, only half the population even has dental insurance. (Even those patients who qualify for state-funded plans are not applying for this benefit.) If you don't have dental insurance through your employer, it's difficult to get insurance (except through Aflac) and rarely worth it anyhow.

Learning About Your Policy

It can sometimes be difficult to figure out what your policy pays for and how much. There are hundreds of insurance companies, and each company has hundreds of different policies from which your employer may choose, each with different payment levels.

We pride ourselves on being able to assist you in researching your dental insurance policy and assist you with understanding your insurance. We will call your insurance carrier for you and verify your coverage and benefits. We then load this information into our computer system so that we have easy access to the benefits and copayments at all times. If your insurance carrier will send us a fax of your benefits, we will give you the fax to take home for your files so that you will have your benefits at your fingertips.

For your convenience, we will file your insurance claim for you and payment will come directly to our office — you will pay only your copayment at the time of treatment. With the information provided by your insurance carrier, we will calculate your co-payment as accurately as possible. Occasionally there are small differences and we will always either credit your account or send you a statement if there is a remaining balance.

Obtaining an Individual Policy

People often ask us how and where they can purchase dental insurance on their own. If you don't have dental insurance through your employer, then purchasing an individual plan would be your only option if you wanted to have dental insurance.

When shopping for a policy, you should carefully consider the cost of premiums against the benefits that you receive. Some of the carriers who write policies for individuals include:

Insurance Alternatives

Many employers offer flexible spending accounts (FSAs), where pretax dollars are set aside for medical and dental expenses. This is an excellent option for reducing your dental expenses. The amount of money you save is based on the tax bracket you are in. In addition, some banks and credit unions allow their clients to open health credit card, much like the old fashioned Christmas Savings Clubs.

Glossary of Terms

COPAYMENT - The portion of the fee that is not covered by the insurance carrier and is due in full the day of service by the patient

MAXIMUM – The annual amount that the insurance carrier will pay up to and not exceed; the average is $1000.

DEDUCTIBLE - Amount patient must pay before insurance will consider payment.

IN NETWORK/PPO - Programs that are designed by the insurance industry whereby the cost of premiums are kept low for employers and the employee must see a dentist that is in the “network or PPO”

FEE SCHEDULE - A schedule of fees associated with services; insurance carriers reimburse based on this fee rather than the amount submitted by the dentist.

WAITING PERIOD - Some insurance policies have limitations which maintain that a person must have the insurance for a certain amount of time before a service can be considered for payment. You will often see this in a PPO policy, and patients must wait until they have had coverage for one year for major services like crowns and dentures.

LIMITATIONS - Some plans have limitations or clauses that apply to the policy. For example, the missing tooth clause states that if a tooth is missing prior to the patient having insurance, then the insurance carrier will not pay to have it replaced. Another type of clause related to time limits will limit a patient to receiving some services only once every five years. Thus if you lose your denture and it is under 5 years old, your insurance may not provide any benefits for replacement.

PREVENTIVE - Any treatment utilized to deter or prevent additional degeneration of the patients oral and overall health prevention such as routine cleanings (sometimes x-rays fall into this category).

BASIC - Any dental treatment performed on individual teeth where decay or injury has jeopardized the integrity of the tooth structure, such as restorative (fillings) and procedures for the treatment of disease, injury, deformity, defect or malformation or the oral cavity and associated structures. This area includes extractions, gum therapy, and root canals.

MAJOR - Dental procedure performed on an individual tooth where the decay has severely undermined the integrity of the tooth and a cast restoration must be placed, such as crowns, bridges, and dentures. Note that some policies have a “missing tooth” clause—if the tooth was extracted or missing prior to having dental insurance, the insurance carrier will not consider payment for replacement.

OTHODONTICS - Coverage for braces.

CLASS I - An insurance category that usually means the company will pay 100% (up to the annual maximum). The deductible usually does not apply. Some insurance carries are now covering radiographs (x-rays) in this category.

CLASS II - Basic dental treatment (restorative, periodontics, endodontics and oral surgery) falls in this category and it is usually less than 100%, The average policy covers 75% of this category, however there are policies that cover 90, 80, 75, down to 50% in this category up to your maximum.

CLASS III - Major dental treatment (crowns, fixed bridges, partials and dentures) fall into this category and is often paid at 50%.

CLASS IV - Orthodontic coverage. Only a few policies have this coverage. The policies that do have this coverage have a once in a lifetime maximum (usually $1000) and they also will have limitations such as no adult orthodontics (treatment for persons under the age of 19 only). This category is usually covered at 50% up to the lifetime maximum.