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Dental Insurance

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A Word About Dental Insurance
Dental insurance is a benefit that your employer provides for you. The reimbursement amount paid by the insurance company to you or the doctor depends on the outcome of prior negotiations between your employer and the insurance company, not on the needs of the patient.

When a dentist “participates” with a dental plan, the dentist agrees that they will lower their fees to the level of a provided fee schedule. In our practice, we do this with a very limited number of plans. Our choice to participate is based on our assessment of the fee schedule, of our perceived ease of working with that company and the companies in our area whose employees we wish to have in our practice. This participation does not guarantee that the insurance company will approve and pay for all necessary dental procedures.

The insurance company makes money by receiving more in premium dollars than they pay out in claims. In order for them to manage their profits, they retain the right to deny claims, delay claims processing and/or impose an “alternate benefit”, which means agreeing, at their discretion, to pay a lesser amount for a less costly procedure than was recommended by the doctor. This is all done under the umbrella of a yearly maximum of dollar amounts that have changed very little, on average, over the thirty plus years of the existence of dental insurance. Yet, during that time the costs of operating a practice and providing new, sophisticated procedures have increased enormously.

Many insurance companies advise that patients receive a pre-estimate for dental treatment. This also results in delay of treatment because insurance companies do not respond to pre-estimate inquiries for 30 days or more, and very frequently request additional information based on guidelines specific to their company on how they regulate a procedure. Both with pre-estimates and claims for completed treatment, correspondence is frequently lost and resubmission requests must be entertained.

The complexity of the dental insurance system invites errors on both sides. Of course patients want to maximize the effectiveness of their coverage, but few understand the incredible maze of paperwork and phone time spent on their behalf to do so. The plan designs are complicated with many variables, terminology that is in a foreign dental language and insurance codes that few lay persons understand. One of our office frustrations is that, because we have decided to extend our patients the courtesy of handling the paperwork, we are all too often caught in the middle of an emotional battle over issues that stemmed from patients not understanding the subtitles of their plan [and rightfully so because of their complexity], or both parties being subject to surprise decisions made by the insurance company beyond our control. Thrown into that mix are mistakes that we make because we are not always familiar with each insurance companies habits and our staff learns by experience. More often than not, our introduction to a new plan happens when a patient presents themselves and their insurance card, and the responsibility then falls on our shoulders to figure it out. We learn by mistakes like everybody else.

The best advice is to treat dental insurance as a useful benefit while keeping expectations low. It is bundled to provide reasonable coverage for routine oral hygiene treatments, preventive and diagnostic procedures, simple fillings and limited advanced treatment per tooth per year. It is not realistic to assume that your insurance benefit was ever intended to cover the cost of major treatment. It is also not our position to alter what we think is best for your dental health in order to conform to the parameters set forth by your insurance company.

We can provide a best guess of the insurance company’s reimbursement based on past history with other claims. At anytime, even after the procedure has been completed and paid for, the insurance company may re-evaluate the claim coverage. This is beyond our control. If you have issues or concerns regarding your insurance benefits and need to speak to someone, your employer has the most strength since they pay the premiums.

Most high quality dental offices that we know choose not to deal with the complexity of the insurance guidelines. In our office we have taken the extra effort to help our patients through this maze of complexity. We urge our patients to remember that your relationship with your insurance company is through your employer, not the doctor. While payment still remains the patient’s obligation, we will file your claim with the insurance company, providing them with requested x-rays and narrative histories. As you might imagine, countless hours are spent on the phone with the insurance company sorting out eligibility, coverage and claims. This is not an easy task, but in keeping with our commitment to the patient, we will continue to file most insurance claims for you.

Price: unspecified

Tags: Dental Insurance

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Dentist in Washington | Russell W Phillips DMD
Date added: 4/1/2010
Expiration date: 3/24/2013
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Offer ID: 219
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Dental Insurance
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