INSURANCE 

For those of you considering signing up for an insurance plan, or for those of you already enrolled in one, here is some general information about it and how our office will work with it.  The whole purpose of dental insurance is to allow an insured individual to take better care of his/her teeth through dentist selection and financial assistance.  There are so many different insurance carriers across the country that there would be no way to include all of them in a simple list.  However, there is a way to categorize the types of plans available, and it is as follows:

Traditional Indemnity Dental Insurance

• You as the patient have the freedom to choose your own dentist
• The levels and coverage are defined by a contract, and generally provide more comprehensive services than PPO’s and DMO’s (as listed below)
• Dentists are paid for services by the insurance company and the patients
• Usually the most expensive, however it is the best of the 3 plans

Preferred Provider Organization (PPO)

• These organizations provide dentistry through contracted dentists who agree to accept lower fees
• Patients have slightly limited freedom of choice in selecting a dentist
• If you visit a dentist who is a “non-preferred provider” you pay more for treatment
• Less expensive than an indemnity plan (above)
• We participate in several of these programs,  see list of PPO's we accept

Dental Maintenance Organization (DMO)

• Minimum dentistry is provided through contracted dentists who agree to a small monthly capitation payment for each employer/patient, regardless if services are performed or not
• Patients are restricted to a list of designated providers and usually must select one provider.
• It is the least expensive plan of the 3, however it is lacking in quality dental services allowed to be provided to you as the patient
• Our office does not participate in any of these programs

Dental Fee Plans

• These are plans, not insurance. Organizations set a list of fees and find dentists who will accept those fees. Several big companies as Costco, Sears offer these programs. Also there are companies who just administer dental and eye plans.
• You pay an annual fee to the company.  They pay nothing to the dentist.  They give you an identification card and provide a list of dentists who are willing to charge their published fees.
• It is a marketing program for dentists.  It attracts patients to an office.
• Generally the fees are compared to a national average or even the average in a high cost area.  You need to make a careful comparison to the actual fees of a dentist in this area to see if enrollment makes sense. I was once signed up with the program of a large national company.  All of their fees were higher than our normal fees.

If you have dental insurance coverage, all we need is the necessary insurance information to submit a claim for you.  As a courtesy, if you wish, we will ask you only for your estimated co-payment.  Please understand this is only an estimate.  Many variables exist from carrier to carrier.  We do our best to find out about these conditions but we cannot guarantee any estimated benefits.  Benefits depend solely on what your employer wishes to purchase.  Some plans cover as little as 30%, others 100%, with most falling in the 40-80% range.  Some plans use a schedule of fees arbitrarily developed by their company which they call “usual, reasonable, and customary fees.”  There is nothing usual reasonable or customary about them to any one but that company; however, it sounds much better that “arbitrary  fees” and makes the dentists look like the bad guys. So, you may be reimbursed at a lower percent than stated.  Your insurance coverage is an agreement between you and the insurance company.  Ultimately, you are responsible for all charges.  If, for some reason, your insurance company has not paid their portion within 60 days from the treatment, you are responsible for payment at that time.  Amounts over 90 days are subject to finance charges of18% APR.