You can use almost any dental insurance plan in our office!
We have over 35 years of experience working with dental insurance companies, and we use that experience every day to help our patients get the maximum benefits to which they are entitled. To protect you against unexpected expenses, we make every effort to verify current eligibility, and research your plan's provisions and limitations. We are experienced dental guides, who can help you navigate through the dental insurance jungle. We know the questions that need to be asked, so you get the answers that you need to know.
1. Are you eligible for services this month? When does your eligibility start and stop?
2. What are your plan's percentages payable for various services? (Preventive, Basic, and Major)
3. What is your plan's annual maximum? Does it go by calendar year, or fiscal year?
4. Is there a deductible? Is it a one-time deductible, or do you have to pay it every year?
5. Are there any waiting periods that must be satisfied before doing certain procedures?
6. What are the allowances and limitations for cosmetic procedures?
7. Is your plan a Premier plan, a PPO plan, or an HMO plan? What does that mean for you, your care, and its cost?
Premier Plans - If you have a (traditional) Premier plan, you can go to any dentist that you choose, and your insurance will pay based on U.C.R. (usual, customary, and reasonable) fees. Your insurance pays the same amount regardless of which dentist you see. Most insurance companies offer Premier plans, because that's what most patients want.
PPO (Preferred Provider) Plans - If you have a PPO plan, your insurance will pay a slightly higher amount if you go to a dentist that is "in network". These dentists have made an agreement with the insurance company to accept 30-50% lower "discounted" fees, in return for being sent a steady flow of new patients.
The BAD thing about PPO plans - While PPO plans can work in the practice of medicine, they don't work very well in dentistry because of very high overhead expenses of about 75-80%. That's because dentistry is very labor intensive, requiring a team of very qualified licensed professionals to deliver quality care. If you add the cost of high-tech equipment and supplies, it just isn't possible to deliver high quality care at a 30-50% discount and stay in business. Something has to give! The dentist is forced to use cut-rate supplies and suppliers. The dentist has to book more patients per hour, or even double-book patients, which translates to less attention per patient. In most cases, either the dentist or the patient will eventually quit the plan because it really doesn't work well for either one. We speak about this from experience! We used to belong to about a dozen different PPO plans, but had to quit them all when we realized that we would have to either sacrifice the quality of our patients' care (which we would never do) or go out of business. When you lose money on every patient, you can't make that up in volume, no matter how hard you work. If you look at the current list of "in network" dentists in our area, you'll see that they represent a very small percentage of the dentists. You'll also notice that the dentist names on the list change yearly, as dentists figure out the bad economics. Many years ago, we decided that we would rather develop long-term relationships with our patients and their families that last many years or decades. If you go to PPO dentists, be prepared to change offices frequently, and don't get too attached.
The GOOD thing about PPO plans - Most of them will allow you to use your regular "out of network" dentist, but they may pay a lesser amount if you do. (For example, for routine fillings, they may pay 80% instead of 90%). We have found that most patients would rather pay a little bit more out of pocket in order to receive more attention and better care from their dental care professionals.
HMO Plans - In these plans, you are assigned to a particular dental office, and in return for a monthly "capitation fee", that one office is responsible for all of your care. You cannot choose your own dentist, and it is very difficult to change dental offices, even to a dental office on the HMO plan's own list. That's because the first dentist would have already been paid for care for the month. This very small fixed amount is paid to the dentist every single month, whether you show up or not. The dentist makes money by keeping patients out of his office, and when he has to see you, he does as little work as possible. That's because the dentist is financially at risk for your care, and in my opinion, that is flat-out immoral. For example, if the dentist has to choose between a 1/2 hour extraction procedure, or a 2+ hour root canal and crown, with hundreds of dollars in lab fees, and that entire amount comes out of the dentist's own pocket, which do you think he will recommend? If you ever receive a recommendation for treatment that just doesn't make sense to you, be sure to get a second opinion!
Assignment of Benefits - Assuming that we can verify your current eligibilty, we'll agree to wait for your insurance payment to be sent directly from your insurance company to us. In that case, we will only ask you for your estimated co-payment, and we're willing to wait months (if necessary) for your insurance company's payment. If your insurance pays more or less that our good-faith estimate, you will end up with a bill or a credit for the difference.
Filing Insurance Claims - In most cases, we have all of the forms and information necessary to file your claim for you. As a free service to our patients, we will handle all of your insurance paperwork, file your claim electronically, and follow-up if necessary.
If you have Delta Dental - We have been participating menbers of Delta Dental since 1974. Because we have a contract with them, all our fees have been pre-approved, so that there are never any surprises. We can get accurate information about your insurance plan, and give you accurate, guaranteed pre-treatment estimates.
It's YOUR Insurance Company - The only insurance that we have a contractural relationship with is Delta Dental. For all other insurance companies, the contract is between YOU and YOUR insurance company. We'll do the very best we can to give you acccurate insurance payment estimates, file your claim, and follow up for you, but we cannot guarantee what your insurance company will pay, or if they will pay anything at all.
As with all questions, please do not hesitate to contact us for assistance. We're here to help make your dental experience a painless one.