A Word About Insurance

TO OUR PATIENTS...

During the past decade, dental benefit plans have become an integral part of health care for many families.

Dental benefit plans are made available to employees or members, through companies, unions and associations, and may vary considerably from one plan to the next. Insurance companies must place limitations on benefits so they can "package a program" for a fixed cost. Programs vary tremendously, according to the cost and other factors pertaining to marketing and the profit margins of the insurance company.

The range of benefits depends solely on what the purchaser (employer) wishes to offer employees or members. Some plans cover as little as 30% or as much as 100% of covered dental services, with most falling in the 50% to 80% range. Some plans exclude certain types of services, i.e., some specialty services, while other plans will cover a more complete range of dental services.

Some plans base the amount of benefit on a chart or schedule of fees arbitrarily developed by insurance companies. For this reason, you may receive a lower percentage of the reimbursement level indicated on your dental plan. For example, if your plan states that it will pay 80% of the cost of dental treatment, it means 80% of the fee arbitrarily determined by the insurance company, not the actual fee charged by your dentist. Also, most dental policies have a maximum annual benefit limitation to further limit the insurance company's expenditures. Comprehensive dental care often exceeds the limitations of the insurance policy or the maximum annual benefits. Thus, dental insurance is rarely designed to meet the needs of comprehensive care. Many policies have failed to increase benefits with increasing inflation. They may also fail to take advantage of newer therapies such as tooth whitening or bleaching.

As the number of patients covered by dental benefit plans has increased, there has been an increase in confusion regarding the role of dental insurance. We would like to make the ethics and principles of dental practice very clear.

1. Professional fees are based on the overhead involved, the treatment plan selected and the time it takes to provide necessary dental care. It is not in either of our best interests for your doctor to compromise treatment in order to accommodate an insurance company's limitation, especially when these benefits that may be less than optimal or harmful to your health. Your doctor will be more than happy to discuss a treatment plan's advantages and disadvantages with you. This discussion will involving you and your benefits, rather than that of your insurance company.
2. The type of treatment you need and receive is based upon the professional judgment of your doctor and not on whether you are covered by a dental benefit plan or the limitations of your insurance plan. In other words, your doctor will determine the treatment that best treats your specific dental needs. Insurance may or may not cover the treatment you need.
3. As a courtesy to you, the doctor's staff will complete the dental portion of the claim form. To expedite processing your claim, please provide your insurance information as completely and accurately as possible.
4. If you direct the insurance company to pay its share of the cost directly to the doctor's office, you will receive credit for this amount, when the payment is made and it will be reflected on your monthly statement.
5. If your dental benefit plan requires predetermination, your doctor will submit your treatment plan for review to the insurance carrier to discover the extent and/or limitations of your policy. However, please remember that the financial obligation for dental treatment is between you and this office.
6. If you receive a communication from your insurance carrier suggesting that your dentist's fee is over or above the usual and customary rate for the services provided, please do not accept this as true without first discussing the matter with your dentist. The insurance carrier's fee data may be out of date, or not take into consideration the local factors pertaining to establishing a fee schedule. Insurance statistics are often manipulated to suit their marketing needs.
7. If, after our discussion, you believe that the dental benefits provided by your plan are inadequate, you may want to discuss the matter with your employer, union or association so that appropriate alternatives can be investigated.

Our office will help in every way in filing your claims, handling insurance queries, processing follow-ups, lost claims, etc. No question is too small for you to ask, whether it is about your treatment, benefit plan or statement. Call any time you have a question.

Your insurance plan has limitations. Some or all of the treatment that will be provided will not be covered by your plan. Our office may not be a contracted preferred provider with your insurance carrier. Regardless, of your plan or your benefits, our office is dedicated to providing you with appropriate and competent care and we will work with your insurance carrier to maximize your benefits within these objectives. We do require that you pay your estimated co-payment in full at the time of service. We will assist you in billing your insurance carrier for the portion of your treatment covered by insurance. It remains your responsibility, however, to pay any balance that remains after your insurance has been collected.