Dental Insurance Dilemma
Due to the complexity of dental insurance plans, we prefer to candidly discuss your dental benefits prior to initiating any dental treatment. This arrangement will prepare our patients for their expected portion of dental treatment at every visit.
It is our pleasure to assist you in completing your dental claim forms. As a courtesy, in addition to filing the claim, we may initially ask you for your estimated co-payment. Please understand that this is only an estimate, and it is based upon the information available to us through your insurance company.
The range of benefits depends solely on what your employer has contracted with your insurance carrier. Some plans may cover as little as 30% or as much as 100% of dental services, with most falling in the 40% to 80 % range.
Some plans base the amount of benefit on a schedule of fees arbitrarily developed by insurance companies. For this reason, you may receive a lower percentage than the reimbursement level indicated in your dental plan. For example, if your plan states that it will pay 80% of the cost of a specific treatment, it means 80% of the fee arbitrarily determined by the insurance company and not the actual fee charged by our office. Your insurance company may try to dictate the treatment by considering some services to be unreasonable or unnecessary. In any event, you as a patient will be responsible for all the charges for the services provided at our office, which may not be paid for by your insurance company.
The financial obligation for dental treatment is between you and our office. We will be happy to assist you in any way that we can. Once your carrier has paid the claim, any difference will be due upon receipt of our statement. If for any reason we have not received your insurance carrier’s payment 30 days from the date of treatment, the remaining balance will be due and payable by you.
We are occasionally faced with following questions from our clients:
“But I have Dental Insurance…..”
An insurance company allows a certain amount for dental expenses per year. Based on the type of treatment, the benefits will vary. The insurance company pays a percentage of the expense depending on the type of service provided. However, when an insurance company says that they cover 100% of a certain service; they mean a 100% based on their fee schedule and not necessarily our office fees. This may leave the patient with a balance toward his or her treatment, despite the insurance company claiming to cover 100% of that type of treatment.
“Do you take my insurance plan?” Or “When are you going to accept our insurance plan?”
We are occasionally asked why we don’t participate in a particular insurance plan, or if we would begin to participate in a plan that is cheaper for the patient to purchase.
As you are probably aware, the health care field is undergoing a period of change in the manner in which care is provided to the public. There are many insurance plans that are being promoted that restrict your choice of doctor to only those on a specific list of participating offices. The participation agreement between those plans and the providers usually requires the provider to deliver care at a discount rate to those patients covered by that plan. For some plans the discount is small, for some it is not.
Our goal has always been to provide quality care. We use the best materials and supplies available in the marketplace. We thoroughly evaluate our laboratories and support services prior to using them. Once chosen, these establishments have to maintain its standards in order to continue to be our service provider. We have an excellent staff of qualified professionals, and we take the time necessary to provide for quality treatment. Although we always look for value, we don’t compromise quality. Our practice has grown and continues to grow through referrals from our patients due to our high levels of quality.
We do not participate in any plan that would encourage a more ‘retail’ philosophy of practice. Dentistry is a service, not a product. For those plans where a filling is a filling and a crown is a crown, it’s always possible to find a cheaper way. For us, the manner in which that service is provided and the attention to details given make all the difference. We do not participate in plans that require us to discount our treatment and encourage us to make up the difference in volume.
However, we have carefully selected some insurance plans where we believe we are not forced to compromise with our quality in order to work with them.
There is enough diversity in today’s dental marketplace for everyone to find a practice whose values they share. We hope this adequately describes our values.