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Below are the frequently asked questions related to insurance answered in this section... How do you utilize insurance in your practice? How is optimal care affected by insurance? How is dental insurance coverage determined? How do insurance pre-determination policies control your care? What are considered "elective treatments" and why? What kind of insurance guidance and help do you provide? How are covered and non-covered services insurance reimbursements developed? What does usual and customary mean and what if insurance pays less than I deserve? How do you determine fees and make them fair to all? __________________________________________________________ How do you utilize insurance in your practice?
The complexity of dental insurance can create confusion. The lack of information provided by some insurance companies can make it virtually impossible for some patients to properly understand their benefits. Another complexity is determining how to properly work with these insurance companies to achieve your highest level of benefits.
Of course, our team is dedicated to providing optimal care and working with you to achieve your goals. We pride ourselves on helping you in any way and in continuing to provide the quality of care you deserve. Please let us know if you have further questions.
How is optimal care affected by insurance?
We are committed to providing you with the highest quality of care that extends far beyond what is considered a standard - or usual and customary. Although our fee structure does fall within many insurance company guidelines, your benefits are determined by the type of PLAN your employer originally purchased from the insurance carrier - not by what other dentists in the area are accustomed to charging (as is typically implied by most insurance companies!)
Every day, it seems, dental insurance is becoming more complex and more difficult to understand. This is often due to an almost insatiable appetite to cut costs. While increased efficiency is helpful and in some areas of medicine costs seem to rise with no reason, the quality of care should not be compromised. Because of this pricing pressure it is important to look at dental benefits as only part of the answer to effective care.
Dental insurance companies are not concerned about coverage for optimal dental care, but provide coverage for only a limited number of basic services. Therefore, Dr. Day finds that insurance plans limit treatment planning capabilities and options.
How is dental insurance coverage determined?
Dental insurance is a contract between your employer and their insurance partner. The benefits you receive are based on the terms of the contract, negotiated between your employer and the dental insurance company. Unfortunately, the dental service providers, like Dr. Day, are not involved in this process. The goal of most dental insurance policies is to provide only basic care for specific services. The services they select are based on the cost to your employer and the negotiated arrangements with the insurance company, which doesn't fully consider the advancements made in dentistry.
This makes dental insurance coverage confusing for many patients. Dental insurance rarely covers an entire treatment fee and, in many cases, covers less than half or nothing.
How do insurance pre-determination policies control your care?
By requiring authorization for your treatment in advance, insurance companies are able to exert more control over the type of care you receive. Our team will do everything we can to help you maximize the benefits to which you are entitled.
Usually, we can begin treatment prior to receiving an authorization from your insurance company. However, patients need to understand that in the event the insurance company refuses to pay for treatment, you are responsible for all fees. Of course, we always provide you with complete fee information in advance so that you know the exact cost of the care we recommend.
We recognize the authorization process is often time consuming and unnecessary, but we strive to make it as efficient and worry-free as possible.
What are considered "elective treatments" and why?
Typically, insurance companies avoid paying for some services. These include: esthetic dentistry, health and function restoring implants, occlusion (bite function) assessment or bite redesign therapy, and other services. While these services can be vital to your complete oral health and greatly enhance your quality of life, dental insurance companies feel they should not have to pay for these kinds of treatments. Therefore, these services are seldom part of a contract with the employer.
What kind of insurance guidance and help do you provide?
We do everything in our power to help you understand and make the most of your dental insurance benefits. We know the complexities of insurance make it extremely difficult to understand how to make it work. Plus working with certain dental insurance companies can increase these frustrations. To navigate this process, we provide full assistance to you.
Our "dental insurance specialists" will complete your dental insurance forms for you to send to the company to achieve your maximum reimbursement.
It is also unfortunate that some insurance companies take longer than others to complete payment. If this occurs, we will contact the insurance company, or we may ask for your help if necessary.
How are covered and non-covered services insurance reimbursements developed?
Your dental insurance company will not, regrettably, cover all of the services that you may require or want. Our goal is to help you achieve and maintain the best possible smile health, which is not necessarily the goal of your insurance company. Their objective is to provide only the benefits negotiated between your employer and the insurance company as being covered, and only at a percentage of their pre-determined fee.
The reimbursement structure, developed by your insurance company, is simply a mathematical method for determining the benefits you will receive and the percentage of our fee that will be paid. We believe following these cost guidelines alone can compromise your care. Therefore, our recommendations don't consider these cost restrictions created by the insurance company.
In addition, each dental insurance plan limits the dollar amount available to you each year. Once the limit is reached, your insurance company, regardless how essential the service may be to your dental health, will cover no other services. If this formula were considered when we developed a treatment plan, most long-term, advanced and/or comprehensive solutions would be deferred indefinitely.
What does usual and customary mean and what if insurance pays less than I deserve?
Usual and customary are terms that identify the average fees deemed by the insurance company - not necessarily determined by fees charged in your area. Insurance companies take the average from a certain geographical region and then take a discount from that average to derive these amounts.
If your plan does not allow payment on the fee charged, your employer may be unaware that other carriers often do deem them acceptable. Again, the quality of the plan is often determined by the ìpriceî your employer was willing to pay for your insurance coverage. Contact your Employee Benefits Director - explore what options are available to you and ask that they research and document your complaint.
How do you determine fees and make them fair to all?
We base our fees on the actual cost of providing superior services, the amount of time this type of care requires, and the long-term value our patients receive from this type of quality care.
Portions of our fees reflect the cost of using highly skilled and knowledgeable dental laboratory technicians and laboratory procedures provided by off-site laboratories to insure that fixed crown and bridgework will look natural and be long lasting.
Our fees also reflect the fact that we choose to employ highly qualified personnel. Staff members in our office are educated in the latest techniques, products and services. They enjoy and are required to attend ongoing continuing education programs on a regular basis - thus assuring our patients that our team has the knowledge necessary to care for their dental needs and show that we stay current with the latest and most effective dentistry available today!
The use of up-to-date dental supplies and equipment, the highest standards of protection are used in the sterilization procedures of instruments, handpieces and water lines. We take every precaution available and necessary to provide and maintain the highest standards of excellence. The cost of research and development is also factored into this process. Rest assured that this process affects our fees - however, we will always choose to protect our patients in the best way possible - regardless of the costs involved or the fees charged!
Our fees also reflect my concern in providing you with quality, long-lasting care including the patient education you desire and require to help you maintain a healthy, beautiful smile.
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