rib-ads

Home |Our Office |Our Services | Staff | Patient Education

INSURANCE POLICY     

Our Insurance Letter

Medical insurance is insurance.  Dental insurance is just a benefit plan.

bullet

Most insurance companies are accepted.  

bullet

We ask that you provide us with your dental health insurance information BEFORE your appointment.   This is so we can provide you with more accurate dental coverage estimates. 

bullet

We will file your insurance claims for you at no charge.  Since we deal with over 200 dental insurance plans will try to give you an guestimate of what your dental insurance MAY cover.  Please remember most insurance companies do not tell you that their usual and customary fees are below what is reasonable an normal for quality dental services.*The insurance company will not tell either one of us what they will pay.

bullet

Often plans tell participants they will be covered "up to 80% or 100%" but do not clearly specify 80% or 100 % of what fee schedule, what annual maximums really are or what their plans limitations are. Insurance companies do NOT cover all dental services

bullet

You may receive notification from your insurance company stating dental fees are "higher than usual and customary". An insurance company surveys a geographic area, calculates an average fee and then takes that fee and considers it customary. Included in this survey are discount clinics and managed care facilities, which bring down the average. Most doctors in private practice will have fees, which are defined as "above usual and customary".

Why Doesn't My Insurance Cover This?
bullet

If you have any questions about your insurance, please contact them directly.  Medical expenses are covered way differently with medical insurance than dental insurance. Medical is an issue of indemnity and dental is simply a prepaid process.

bullet

Each patient is responsible for his or her deductible, co-pay, and any procedures not covered by your insurance at time of service.  We are not a party to the contract between the employer and insurance company. We aren't a "contracted provider". 

bullet

Insurance companies almost always notify patients of a payment before sending this payment to a dentist.  If there is a remainder that the insurance company did not pay than we will bill you for the remaining balance, however, there is a billing charge after 30 days of nonpayment.

bulletYou understand that we will not be responsible for knowing the various scenarios in which your insurance does not pay for whatever reason. Such scenarios include such things as pre-existing conditions, waiting periods, x-rays which can only be paid on every so often, less costly alternative provisions, required pre-authorizations, etc. Your insurance company may use these and other reasons for avoiding payment of your claim. We will not be responsible for knowing these various intricacies of your particular insurance contract. You will need to be responsible for knowing all these details and advising us because insurance companies refuse to provide us with these details.
bullet

Insurance companies that we do not accept, we will gladly provide a doctor statement that will give you all the information you need to meet your insurance company’s requirements for filling claims.  You will pay for services at time service is rendered and than you will directly receive a check from your dental insurance company. 

bullet

Call the New York State Dental Association at 1-518-465-0044 for a free brochure entitled, "Are You Missing Out on the Dental Benefits You Deserve?"

Insurance Terms: Dental Benefits Terminology

I Don't Have Enough Money to Fix My Teeth

In 1960, the average maximum benefit paid by insurance carriers was $1,000  per year. In 2005, the average is still approximately $1,000 per year. Can  this be true? Yes! An ever-increasing number of patients cannot gain access  to needed dental services because the maximums have not even kept pace with  inflation. Is there a solution? Absolutely. A Blueprint and Direct
Reimbursement.

A "Blueprint" is a complete and full treatment plan, customized to your  wants and needs, that will allow you to phase in ideal treatment over a  period of time leading to the ultimate goal of ORAL HEALTH.

"Direct Reimbursement" dental benefit is a simple reimbursement system that  preserves your right to choose treatment with minimal paperwork and no preliminary authorizations. Employers who select this alternative benefit plan can save money and purchase plans that provide cost-effective services for employees. 

 

*Contemporary Esthetics and Restorative Practice, G I Johnson,  July 2001 pg 44

Why Doesn't My Insurance Cover This?

  September 28, 2008

 Back    Financial Information   Office Information    Home 

 
ads

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
Confidentiality of data including your identity, is respected  by this Web site. We undertake to honor or exceed the legal requirements of medical/health information privacy that apply in Nebraska.

Copyright ©1998-2017 Family Gentle Dental Care, all rights reserved.