Financial Arrangements

Can I really save 40 percent by using "In-Network" doctors?

I think it is wrong for insurance companies to try to "undercut" well-intentioned doctors.

Yet this happens when they encourage patients to see an in-network doctor and save a perceived 40 percent. In-network doctors cut their fees for one reason only – so that the insurance company will send patients to them. This is a great deal for the insurer because it reduces expense, and in the end the patient pays more of the fee.

But in order to perform dentistry at such a low cost, the dentist must make major cuts in overhead:

• Simply "watching" an area of decay or a broken tooth, because it is not financially worth the time to repair it.
• Using a cheaper, inferior lab to fabricate crowns, resulting in poor cosmetics, fit, seal, and improper bite.
• Overcrowded waiting rooms where patients sometimes sit for more than an hour.
• Entry-level office personal that may be inexperienced or have no dental background at all.
• Possible compromises in cleanliness and sterility by cutting corners through re-using items.

What you should know if you have dental benefits?

We believe that you deserve unsurpassed care. That is why we present you with the best dental solution for your personal situation. If you have dental benefits, congratulations! Many are not so fortunate. Here are some important things you should know about dental insurance:

• Dental benefits are based upon a contract made between your employer and an insurance company. If you have questions regarding those benefits or if you are dissatisfied with the reimbursement, please speak with your personnel department (human resources director) for advice on a proper, comprehensive dental plan. You may also contact the insurance company directly.

• Dental benefits differ greatly from medical insurance. In 1959, most dental plans had a yearly maximum of $1,000. Surprisingly the average dental benefit plan today still has a yearly cap of $1,000. That is the equivalent of $139 in today's figures. There has been no significant increase in the yearly maximum cap in more than 50 years. However, dental insurance premiums have risen over 1,200 percent in that same period of time!

• You may receive notification from the insurer that your dentist's fees are "above usual and customary." An insurance company determines reimbursement level by surveying a geographical area. Included in this survey are Medicaid government clinics, discounted dental clinics, and managed care facilities – all of which charge severely reduced dental fees and bring down the average. The calculated average fee is then further reduced by an about 25 percent. So, an insurance company's "average, usual, and customary fee" by their own definition is much lower than average!
  
  This lessens the amount they pay the doctor, and raises the amount the patient pays. It implies that the doctor is charging an inflated fee and persuades the patient to change to an in-network provider.
  
  I simply strive to provide the best for my patients. And, as with any doctor in private practice, will have fees that insurance companies define as "higher than usual and customary."

• Many dental benefit plans indicate that they cover "80 to 100 percent" but do not clearly specify the plan fee schedule allowance, annual maximum, or limitations. It is more realistic to expect benefit plans to cover 30 to 50 percent of the cost of dental services. Dental benefit plans will never pay for all of your dental care. They are only meant to assist you.

• Insurance companies do NOT cover many routine, state-of-the-art, or highly advanced dental services.

Our team members will gladly assist you in filling out forms necessary to maximize your dental benefits, and discuss your financial options. Excellent dental care is available with or without dental insurance. We hope you will choose the best that dentistry has to offer.

Dentistry is a profession that demands individualized attention. As doctors, we have a responsibility to take proper care of individuals and families. We are not selling a product or commodity. Dentistry should not depend on low-quality, high-volume sales.