Dental Insurance
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QUALITY OF THE PURCHASED INSURANCE:
Many of our valued patients have the privilege of having dental insurance. Your dental
plan is a form of compensation your employer provides, a coupon to be put toward
offsetting the fees for the care you need. You may expect the carrier (insurance
company) to reimburse you for a portion of our fee. That portion is determined by the
contract between your employer and the insurance company. The higher the premium
paid by your company, the more generous the reimbursement. Your dental insurance
policy is an agreement between you and your insurance company. We are only a third
party to this contract.
QUALITY SERVICE vs. "COST EFFECTIVE ALTERNATIVE"
BENEFITS:
Please remember that our philosophy of dental care is to provide the best oral health
possible for our patients regardless of insurance policy limitations. To do otherwise
would violate our pledge to you - the only contract we feel morally and ethically
privileged to honor. Therefore, as caring professionals, we will recommend treatment
based on our extensive training in the field of Dentistry. Many insurance companies
“determine that an alternative method of treatment is as appropriate and cost-
effective" as the treatment planned by us. Eventually, in many instances, the “cost-
effective” option leads to more extensive treatment. Therefore, we diagnose and
recommend the BEST customized treatment options based on each individual’s needs.
OUR OFFICE: With most insurance plans we do accept ASSIGNMENT of BENEFIT
(where you authorize your insurance company to reimburse our office directly) unless
otherwise restricted by your individual plan (some Delta plans or HMO's)
For instance, after you authorize ASSIGNMENT of BENEFITS, Plan A may reimburse our
office directly, whereas, Plan B may reimburse you directly regardless of your
authorization (i.e. some Delta PPO plans).
Please be aware of these variations and familiarize yourself with your particular plan. As a
courtesy, our office will assist you in preparing and submitting the necessary forms for
these benefits. We make every effort to work with you to receive the CARE that you
deserve and also with your insurance company so you would receive the maximum
reimbursement to which you are entitled.
INSURANCE COMPANIES: Ultimately the insurance companies determine the
reimbursement when they receive a claim. Please remember NO company attempts to
cover all dental costs. Here are some variations on methods of calculation for benefit
reimbursement used by these companies:
balances not covered by your insurance company. (For an ideal example: if the fees for
your appointment were $100.00 and your insurance will only estimate to cover 80% of
that procedure, you would be required to pay $20.00 for that visit). If the reimbursement
payment is not received from your insurance carrier within 45 days from the date of
service, as a courtesy we will inform you of this delay first and have you get in touch
with your company to reimburse you directly; however, we require that you pay the
remaining balance immediately.
Many of our valued patients have the privilege of having dental insurance. Your dental
plan is a form of compensation your employer provides, a coupon to be put toward
offsetting the fees for the care you need. You may expect the carrier (insurance
company) to reimburse you for a portion of our fee. That portion is determined by the
contract between your employer and the insurance company. The higher the premium
paid by your company, the more generous the reimbursement. Your dental insurance
policy is an agreement between you and your insurance company. We are only a third
party to this contract.
QUALITY SERVICE vs. "COST EFFECTIVE ALTERNATIVE"
BENEFITS:
Please remember that our philosophy of dental care is to provide the best oral health
possible for our patients regardless of insurance policy limitations. To do otherwise
would violate our pledge to you - the only contract we feel morally and ethically
privileged to honor. Therefore, as caring professionals, we will recommend treatment
based on our extensive training in the field of Dentistry. Many insurance companies
“determine that an alternative method of treatment is as appropriate and cost-
effective" as the treatment planned by us. Eventually, in many instances, the “cost-
effective” option leads to more extensive treatment. Therefore, we diagnose and
recommend the BEST customized treatment options based on each individual’s needs.
OUR OFFICE: With most insurance plans we do accept ASSIGNMENT of BENEFIT
(where you authorize your insurance company to reimburse our office directly) unless
otherwise restricted by your individual plan (some Delta plans or HMO's)
For instance, after you authorize ASSIGNMENT of BENEFITS, Plan A may reimburse our
office directly, whereas, Plan B may reimburse you directly regardless of your
authorization (i.e. some Delta PPO plans).
Please be aware of these variations and familiarize yourself with your particular plan. As a
courtesy, our office will assist you in preparing and submitting the necessary forms for
these benefits. We make every effort to work with you to receive the CARE that you
deserve and also with your insurance company so you would receive the maximum
reimbursement to which you are entitled.
INSURANCE COMPANIES: Ultimately the insurance companies determine the
reimbursement when they receive a claim. Please remember NO company attempts to
cover all dental costs. Here are some variations on methods of calculation for benefit
reimbursement used by these companies:
- 1. Fixed allowances for a specific procedure(i.e. a flat $75 for an exam)
2. Arbitrary UCR(Usual-Customary-Reasonable) formula based on internal plan
controls and carried out at the sole discretion of that plan. (this is a tricky one
because this can change annually or even monthly usually for the insurance
comapnies' profit margin!)
3. Straight Percentage of the submitted fee for services.(i.e. 80% of submitted
fee)
4. Downgrade to a more ”cost effective” fee for their company. In other words,
any variation of 1,2 or 3 but applied to a lesser yet "cost Effective" treatment
reviewed by a claim adjuster(usually not even a licensed dentist!) (i.e. only
covering 80% of the procedure DOWNGRADED to a "Cost effective
Alternative", leaving you to pay the 20% copay and the difference between the
alternative fee and true fee submitted)
5. Denial any payment based on limitations in each individual plan( i.e. time
limits" WAITING PERIOD"/pre-existing condition/replacement clause/"not a
covered expense" etc.)
balances not covered by your insurance company. (For an ideal example: if the fees for
your appointment were $100.00 and your insurance will only estimate to cover 80% of
that procedure, you would be required to pay $20.00 for that visit). If the reimbursement
payment is not received from your insurance carrier within 45 days from the date of
service, as a courtesy we will inform you of this delay first and have you get in touch
with your company to reimburse you directly; however, we require that you pay the
remaining balance immediately.
Copyright 2004 Naperville Family Dental Care
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