OUR TEAM

Claim submission:
We will electronically submit your insurance claim form to your insurance company for you after your treatment is completed.  Today, most insurance companies allow us to submit our claims to a clearinghouse that will forward the claim on to the insurance company for quicker review and payment.  Some carriers do not take electronic claims yet, and these claims are printed and mailed by the clearinghouse.  Along with the claims processing, we also submit photos and x-rays electronically.  Again not all companies accept electronic attachments so we occasionally have to submit claims via U.S. Mail when x-rays or photos are needed by these carriers. Insurance Affiliations:
We are proud to say that we do not belong to any HMO plans nor any PPO plans. The only affiliation we have is the Delta Detial Premiere Network .We know that this may cause us to lose some patients when they are looking for in network dentists, but we are proud to say that we believe we offer treatment in a high tech environment, we use only the best materials, and the highest quality labs. Participation in insurance plans fixes costs below our standard of treatment and operating costs. We will not sacrifice quality dental work for a higher quantity of insurance referrals.

If you do have an HMO, you MUST see a dentist in your network to get coverage. If you have a PPO, your insurance company will most often pay for your treatment at any dental office, in network or out of network. An In Network dentist has agreed to lower his fees for the insurance referrals, while an out of network dentist has no contract with the insurance carrier. When patients go out of network, coverage amounts are often the same as in network, but some policies have a lowered coverage.  Check your policy for details.  As we have said, we are proud to say that we feel we offer the top of the line in materials and are proud to say that we are Out of Network for every plan but the Delta Premiere.  

 

 

What is dental insurance?

 

In most cases insurance is something that is important to have.  It will financially protect you and your assets and pay for something after a problem arises.  For example, car insurance pays for problems after a car accident.  Home insurance pays for repairs around the house. Medical insurance pays for medical treatment, whether preventive or due to injury. Dental insurance is a little more confusing.  Dental insurance is a contract between your employer and an insurance company.  The benefits you will receive have been negotiated between your employer and the insurance company. Your dentist has no part in these negotiations. Dental insurance usually has relatively low yearly maximums, restrictive coverage rates, and quite a bit of exclusions. The benefits you receive from the dental insurance company have nothing at all to do with you  or achieving a high quality complete result. 

Think of Dental Insurance as a Coupon
Most policies are designed to help pay for basic care and specific dental services. 
Because they only help pay, we look at dental insurance as having a coupon.It is nice to have if it applies to your specific needs, but coupons are rarely designed to pay for things in full, and if you don’t have one, you still need the product, or in our case, you still need the treatment.  Our goal is to help you achieve and maintain optimal dental care, which is not necessarily the goal of your dental insurance company.  We will try to work with your insurance policy and its benefits, but we do not want to compromise  your care based on the restraints place on your policy by your employer and insurance carrier.

 Managed Care versus Freedom of Choice

Our philosophy is that insurance coverage does not, nor should it dictate optimal dental treatment.  Unfortunately, many patients have lost the rights to choose their own dentist, and therefore, lose their ability to seek the treatment options they desire, and deserve.   Managed Care plans (HMO/DMO) plans require you to select a primary dentist from a list, and you cannot go anywhere else.  The plan may look good on paper, but buyer beware.

Another common policy offered is the PPO plan.  These plans allow you to select from a list as well, but unlike the HMO/DMO plans, you have the flexibility to be able to go outside the plan and still have some coverage.  Not as common today are the traditional insurance plans allow you to go anywhere you like, and seek the best treatment possible.  These are the best, but cost the most.  Finally, some employers offer Medical Savings Plans that offer pre-tax salary deductions that can be used to pay for medical/dental treatment according to the individual plan set up.  To learn more about these plans consult the latest IRS publications for the most current laws (they change often).

WHAT DO YOU DO IF YOU ALREADY HAVE A MANAGED CARE POLICY?

Make it clear to your employer that you would prefer to have the freedom to choose your own dentist rather than be forced to see someone on their list.  It is often helpful to share this information with other employees and friends.  When groups of employees approach employers looking for change, the chance of getting the option to have a PPO or Traditional Insurance policy is better.  Remember, employers want to save on premiums and insurance companies want to save on payouts.  Their job is not to care what is best for you.

 

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OUR PHILOSOPHY

Insurance & Billing
We will happily submit your claims for you after your treatment.  Our software estimates insurance coverage amounts from payment on previous treatments, or average insurance company coverages.  Please understand that the cost of treatment is not dictated by insurance coverage, and that any unpaid insurance balances, or copayments, are your responsibility.  We do not ask for payment in full for your treatment prior to treatment as some offices do,  but we do ask that you pay any estimated balances in a timely manner.  We will bill your estimated copayment at our regular billing cycle if the claim has not yet been paid. HIPAA Privacy Practices