People often ask if I take insurance: a tricky question, because it can have two meanings. On the one hand, I'm happy to fill our your insurance company’s forms. In fact, I submit them on line, so that you'll be reimbursed more quickly.
On the other hand, I do not accept any insurance company’s payment as full payment for my services. For most procedures, an insurance company’s payment is well below the price that I usually charge—often barely half of the “customary and usual” fee. The provider is expected to be able to make up the difference through volume, by filling his schedule with other patients referred by the insurance company. You've probably sat for hours in the waiting room of a health-care provider who participates in insurance plans: that’s because the conscientious physician or dentist is struggling to get through a crowded schedule that often allows only a quarter- or half-hour for procedures that should take much longer.
I respect my patients and myself too much to work that way. My fees are not arbitrarily set: they depend on the time required for a procedure, its difficulty, and the materials required. I schedule enough time to do procedures properly. I constantly monitor the dental labs that I use to produce crowns, dentures, veneers, and so on, making sure they produce superior work that often fits perfectly on the first try, and that will last as long as possible. A typical insurance payment will often not even cover the price of good-quality lab work, never mind your time with me.
Can anyone but me tell the difference in quality? Apparently so, since I often see patients who have been to a dentist who participates in their insurance plan, but have come back to me for major work or to fix dental work that was poorly done. Did you know that a simple filling requires up to 15 separate steps? Skimping on any one of them can cause the filling to fail prematurely. Imagine the possibilities if your dentist rushes through the steps of a more complicated procedure—for example, making a crown or doing a root canal—because half a dozen patients are backed up in his waiting room.
So: my fees are what they are for very sound reasons, and I do not accept any insurance company’s determination of what they ought to be. I want your business on mutually acceptable terms: your satisfaction with work well done, and my full price for it. Yes, you will be responsible for whatever part of my fee your insurance company does not pay. But I will be happy to help you find out how much they allow for various procedures, and to discuss a range of treatment plans to fit your budget, so that you can make an informed decision about what you want done.
If you have general questions about dentistry that you'd like to see addressed on this blog, feel free to email me at sdurante@earthlink.net . The information on this blog is presented for general education only: consult a dentist for advice on specific problems, diagnoses and treatment.
Good post! Are there any insurance plans that you prefer over the others?
ReplyDeleteInsurance companies offer many plans with many levels of coverage; it depends what your employer, or whoever provides your insurance, purchased from the insurance company. With that said there are general categories:
ReplyDelete1. The most restrictive is the DMO. Dental Maintenance Organizations require the patient to see a dentist from their list. The dentist is usually paid a monthly fee by the insurance company whether the patient ever seeks care or not. If and when he does, some sort of care must be provided, sometimes with the doctor receiving additional payment from the insurance company, sometimes not. Very risky for all involved in my opinion. Needless to say, I am not on any DMO lists.
2. PPO, or Preferred Provider Plan, is less restrictive. Here the "participating dentists" on the list agree to accept a lower than normal fee and the patient agrees to pay some portion of that fee with the insurance company paying the balance. These PPO plans often have a fee-for-service provision in case the patient does not want to see a dentist on the list of participating dentists.
3. Fee-for-service is the least restrictive. You see any dentist of your choice, discuss and arrange for payment of the fee with the dentist. Then the insurance company reimburses the patient based on the provisions of the particular insurance plan. If you must have dental insurance I believe this is the best kind of plan, as it works in the background, so to speak, leaving the dentist and patient free to think and act without interference.