Kusp Pediatric Dentistry

Why Doesn't My Dentist Take My Insurance?

Many people get very upset with their healthcare providers when they hear that their provider may not accept all types of insurance.  We are not always the bad guys! There is a major issue with dental care in the US, many people can’t afford dental care because the cost is so high and also, the cost of dental insurance is insanely high. What gives?! While insurance can provide benefits to both patients and dental practices, there are factors that may lead dentists to make this decision. Insurance companies typically negotiate reimbursement rates with dentists, and these rates may not always align with the actual cost of providing quality dental care. In some cases, the reimbursement rates offered by insurance plans may be lower than what dentists believe is fair and reasonable for the services they provide, especially because in the US becoming a dentist can cost upwards of a million dollars after loans, practice ownership, etc. This can result in financial strain on dental practices.

Dental insurance forms - Kusp Pediatric Dentistry in Beverley Hills, CA

 Insurance plans often have limitations and restrictions on certain treatments or restrictions on the number of visits or services allowed within a given time period. Dentists who prioritize comprehensive and personalized care for their patients may find these limitations to be restrictive and not in line with their treatment philosophy. This limits their ability to make treatment decisions based on their professional judgment and the individual needs of their patients. By opting out of insurance, dentists can focus on providing the highest quality of care without being limited or influenced by insurance company policies.

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The cost of dental school in the United States can be between $200,000.00 and over a million dollars for some dentists that complete speciality training programs. Further, if a dentist chooses to open a dental practice this can also cost a minimum of $500,000.00 and more. As such, to be able to pay for all the debt that is accrued to be able to practice dentistry, a dental professional simply must (like any business) generate enough monthly revenue to cover the expenses. Low reimbursing insurance companies put dentists in a scenario where they must see many, many patients per day (often compromising the patient experience) in order to reach that revenue. Further, many dental insurance companies may not agree to cover some treatments that a dentist may deem necessary. To simplify, taking dental insurance becomes a very personal choice – and often a difficult one for dentists. On the one hand, we want to accept insurance to help better serve the patients who have it and on the other hand, we need to make sure it makes financial sense for us to do so. 

So, if you are one of the those individuals who has a dentist you love but end up out of network with them, have a conversation with your provider, they can explain in more detail why they choose to be out of network with your particular insurance and may provide payment plan options if you choose to continue seeing them and pay out of pocket.