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Dental Insurance
Almost all dental patients have some form of dental insurance. These benefits are very different from medical insurance. Dental insurance gives patients a minimal yearly benefit maximum to cover dental needs. As the cost of dentistry has risen over the years, the maximum yearly benefit insurance companies provide has changed little.
An HMO or DMO insurance program gives the patient a list of providers that they must choose from. Patients can not go out of the network to utilize this benefit. A PPO program gives the patient a list of providers that have agreed to discount their fees and to work within guidelines the insurance company has dictated. Patients with PPO plans can go outside the network to the provider of their choice and utilize their dental benefits.
It is important for patients to have a choice and for providers to be able to do what is best for the patient with out being dictated to by an insurance company. When a patient goes out of the network, the insurance company will pay what they determine is “usual and customary”. This is an arbitrary amount that is different from insurance company to insurance company. Patients can utilize their benefit with an out of network doctor of their choice.
In our office, insurance claims are filed electronically. Patient’s pay in full for visits of $200.00 or less. If procedures are over $200.00, the patient pays the required deductible and an estimated portion of the treatment. Balances remaining after insurance payment are billed to the patient.
In dentistry, insurance is merely a benefit that covers a portion of dental cost. Some plans are good while others are weak. We help our patients realize the true limitations of dental insurance, but we also help them to utilize their benefit to its maximum. |
