Insurance

Insurance

We are currently providers for Delta Dental and Signature Care dental insurance plans.

During the past several decades, dental benefits have become an integral part of health care planning for many families.
Dental benefit plans are made available to employees or members
through companies, unions and associations, and may vary
considerably from one plan to the next.

The range of benefits depends solely on what the plan purchaser wishes to offer to employees or members. Some plans cover
as little as 30% or as much as 100% of the fees for dental
services, with most falling into the 50% to 80% range. Some
plans exclude certain types of services, such as orthodontics,
while other plans cover a full range of dental services.

Some plans base the amount of benefit on a chart or schedule of fees arbitrarily developed by insurance companies. For this
reason, you may receive a lower percentage of the reimbursement
level indicated in your dental plan. For example, if your
plan states that it will pay 80% of the “usual and customary”
cost of dental treatment, it means 80% of the fee as determined
by the insurance company, not necessarily the actual fee
charged by us

As the number of patients covered by dental plans has increased certain assumptions have become evident. We would like to
make clear the principles of our practice, as well as the
types of service and care we provide our patients:

  • Our fees are based on the overhead involved in our practice, the treatment plan selected, and the time it takes us to provide
    you with the necessary dental care. We do not believe
    that it is in either of our best interests to compromise
    the recommended treatment to accommodate a dental plan’s
    maximum benefits. However, we are more than happy to
    discuss a treatment plan’s advantages and disadvantages
    with you to accommodate you in the health care decision-making
    process.
  • The type of treatment you need and receive from us is based on our professional judgment and not on whether you are covered
    by a dental benefits plan.

  • As a courtesy to you, our staff will file your claim.
  • If you direct the insurance company to pay its share of the
    cost directly to our office, you will receive credit
    for the amount and be billed for the balance. Upon receipt
    of payment from the third-party, our staff will reconcile
    the amount, and bill or refund any difference.

  • If your dental benefits plan requires a “pre-determination” or “prior authorization,” we will submit a treatment plan for
    review by the third-party payer. However, please remember
    that the financial obligation for dental treatment is
    between you and this office. The third-party payer is
    responsible to you and not this office.

  • If you receive communication from the third-party payer suggesting that our fee is over and above the “usual and customary
    rate” for the services provided to you, it may not take
    into account local factors pertaining to Columbia City/Roanoke
    in establishing its schedule. Additionally, its geographic
    area may include the entire county or state. Insurance
    companies do not, and are not required to, divulge how
    they arrive at these numbers and often try to imply that
    out-of-network providers (i.e. doctors that refuse to
    join the insurance company’s plans) overcharge their
    patients by providing low “usual and customary” fees.
  • If, after our discussion, you believe that the dental benefits provided by your plan are inadequate, you may want to discuss
    the matter with your employer, union, or association,
    so that appropriate alternatives can be investigated.

We will file your claims, handle insurance queries, process follow-ups or lost claims, etc. No question is too small for
you to ask, whether it is about treatment, benefit plan,
or statement. Stop in, or call, any time you have a question.
We are here to help you.