Financial & Insurance Questions
In most cases this is a question of cost versus quality. Many dental offices have chosen to sign agreements with dental benefit plans that require the dentist to adhere to a discounted re-imbursement schedule that is dictated by the dental benefit plan. Unfortunately the re-imbursement schedule is set arbitrarily by the dental benefit plan in order for the dental benefit plan to maximize their own profits. In turn this means that the dentist is forced to provide the same service and be re-imbursed at a lower rate. In practical terms this means that you as the patient will receive more services in a shorter period of time to compensate for the lower re-imbursement schedule (i.e. you will receive a cleaning, xrays and exam in 60 mins vs in 90 minutes as we currently schedule at our office).
We have chosen to remain free from the constraints of contractual obligations with insurance companies because we believe that it allows us to provide our patients with the highest standard of care possible. We perform yearly audits to confirm that our billing practices and fees are within industry standards and are often told by patients that dental costs are similar or less at our office by comparison to “in network” providers.
With health insurance, you typically pay your deductible and then a percentage of the remainder of the costs, while the medical insurance bears the majority of the cost once the deductible has been met. Dental coverage is the opposite. Most plans still have deductibles but they are very small (on average between $50-100). Dental benefit plans cover a percentage of all of the dental care that you receive up to a specific dollar amount (often $1,000, $1,500, or $2,000) and any care that is received above that dollar level is the responsibility of the patient.
Having dental insurance or a dental benefit plan can make it easier to get the dental care you need. But most dental benefit plans do not cover all dental procedures. Your dental coverage is not based on what you need or what your dentist recommends. It is based on how much your employer pays into the plan. Dental plans are a contract between your employer and an insurance company. Your employer and the insurer agree on the amount your plan pays and what procedures are covered. Often, you may have a dental care need that is not covered by your plan. Employers generally choose to cover some, but not all, of employee’s dental cost. If you are not satisfied with the coverage provided by your insurance, let your employer know. If you have any questions about coverage it is up to you, the patient, to contact your employer and or/insurance company. (excerpt from ADA insurance pamphlet)
We do not prepare pre-treatment authorization and submit them to your insurance company for approval. Receipt of an approved pre-treatment authorization in no way guarantees payment by the insurance company. All insurance companies have informed us they will consider claims for treatment ONLY after the treatment is complete. In essence, we don’t want to mislead a patient into believing that a procedure is a covered service if the insurance company decides to change its policy and the procedure becomes the responsibility of the patient.
- • See Financial Policies.
- • We bill up to two insurances as a courtesy to the patient.
- • Even though you may have one, two, or more dental benefit plans there is no guarantee that all of the plans will pay for your services. Sometimes, none of the plans will pay for the services you need. Each insurance company handles coordination of benefits in its own way. Please check or contact your carrier/plans for details.
At this time there is no dental benefit associated with the Medicare program. Supplemental dental benefit plans can be purchased but this falls outside a standard Medicare plan.
At this time we are not a Medicaid Provider.