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.