Insurance Questions
It would be insurance fraud to charge for services not provided on the date listed on an insurance claim. Both the patient and dentist can be prosecuted for this. While we will do everything possible to obtain dental benefits for you, we will not falsify documents or the need for treatment.
Many specialists are no longer preferred providers for dental insurance. This is because reimbursement to the preferred provider generally falls way below the actual cost of providing complete and comprehensive oral health care to you. Dental benefits have not kept up with the actual cost of modern dental care. Twenty years ago, most dental insurance plans had a per person maximum between $1,000 and $1,500 per year. Most annual caps are still in that range even though modern dental care can and does provide better that that in turn allows patients to keep their teeth longer and maintain better overall oral health care. New data shows that dental benefits would need to be about $6,500 per year to keep up with inflation. These improvements in oral health care come with a cost in terms of equipment, materials, training and staff salaries. As a dental care provider, we do not want to compromise your oral health by only providing services that an insurance company authorizes. We cannot afford to accept what insurance companies allow as payment to a preferred provider and still maintain an excellent, well-trained staff and modern equipment.
No. Insurance companies have a fee schedule that is not based on complete and comprehensive dental needs. Rather, the fee schedule is based on arbitrary fees on a zip code basis. Your dental insurance company’s bottom line is profit margin, while we are concerned about helping your dental and oral health.
That 100 percent usually refers to what the insurance industry allows under a “usual, reasonable and customary” clause, not what your dentist or a dentist in your area charged. A fee schedule of “usual, reasonable and customary” fees is based on your geographic location in the country, not the type of care to help you keep your teeth.
Yes, we file all insurance except Medicare, Medicaid, discount plans and military plans. We will file all other insurance if you provide our staff with the current insurance information (policy number, group number, mailing address, phone number and/or a copy of your dental insurance card). Our financial coordinator will prepare and mail claims for treatment provided, and our treatment coordinator will prepare and mail pre-determinations as you may request, with necessary documentation provided.