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Insurance

 

Dental insurance can help defray some of the costs of dental care. This type of insurance is very different from medical policies. There are yearly deductibles, yearly maximums, certain percentages paid on different procedures, waiting periods, timing limitations on cleanings and x-rays and many exclusions regarding benefits. Dental consultants, who have never seen the inside of your mouth, also scrutinize us! They are the ones who decide in a complicated case what will be covered. There is also this tricky little thing called the UCR (usual, customary and reasonable) which one would think would be set and regulated, but each plan has its own version. And there are about 6 versions per zip code. While the cost of everything we use in the office has gone up, insurance benefits have not changed since the 1970’s. Maximums and allowable services have not changed with the times.

This office is a participating provider with Delta Premier Plan. And there are several of those that offer Point of Service benefits. This type does not always pay up to the Premier standard, so it is always a good idea to check online to see how you are covered.  We also are participating providers with BlueCross/BlueShield Traditional, PPO, and Federal Employees Program.  Although we are considered out-of network with other insurance companies, in most cases the patient is entitled to out-of network benefits, which are often times, equal to those you would receive in-network. It is always helpful to have a copy of your plan, along with your insurance card, easily downloaded from your carrier. Bring this with you and we can translate it into English instead of “insurance speak.”

As a courtesy to all our patients we will submit your claim electronically to any carrier. Just remember, the more you educate yourself about your insurance the more we will be able to help you navigate it. Questions concerning insurance should be directed to the carrier, since we are considered a third party. If you don’t like the answer you get we will help you appeal.  We will do everything within our power to help you legally maximize your benefits. You however are still responsible for any shortfall between our fees and their payments.