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OUR
POLICY REGARDING INSURANCE
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We
enjoy working with families who are covered by dental insurance, and we
are totally committed to assisting our patients realize their maximum
benefits. Patients are reminded that their policy is an agreement between
them and their insurance company and not between the insurance company and
this office. Consider dental insurance as a scholarship from the employer.
It is designed to assist patients financially with their dental care.
As a courtesy to our patients, we will be happy to complete and forward
insurance forms relative to dental treatment, and we will do so without
charge. However, in order to avoid misunderstandings, please read
carefully and understand the following policies in regard to dental
insurance benefits.
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Our
professional treatment is rendered to you, not the insurance company.
You are responsible to us for the obligation of payment of
treatment.
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However,
to serve and assist you in utilizing your dental insurance, this
office accepts assignment of your benefits. It is your responsibility
to provide us with insurance forms assigning payment to this office
and you are responsible for balances not covered by your policy on the
day of service.
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Some
policies request a "pre-authorization" or
"pre-determination" before treatment is begun. We will
submit a treatment plan for review by your insurance company if this
is a requirement. We can make no guarantee of any estimated coverage
and you will be responsible for the cost of the treatment should the
insurance benefits result in less coverage than anticipated.
Please
remember that dental insurance is designed to assist people to obtain
dental care and rarely covers more than 30 to 50 percent of the total cost
of service. There may be a deductible, a co-insurance factor, and a yearly
maximum to be considered.
Most
policies cover what they consider a "usual and customary fee".
However, the insurance company sets these fees, and they are not always
the same as the fees that may be charged in this office.
All
these factors may contribute to reduce the benefits you will ultimately
receive. We will do our best to see that you receive your full benefits
within the structure of your particular dental plan. However, the ultimate
responsibility for payments is yours and financial arrangements must be
defined before dental treatment can begin.
Please
understand that the amount to be paid by your particular policy is
pre-determined and agreed to by your employer and the insurance company.
At your request, this office will provide all pertinent information to
your insurance company and we will do our best to help you derive the
maximum benefits available. However, we are not responsible for
determining what those benefits are to be. If you have any questions about
the amount the plan will pay or the treatments your plan will cover, you
should refer these questions to your employer.
Please feel free to call the office at (770) 251-6868 as our staff will be
happy to assist you with any questions on insurance.
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Coordination
of Benefits - If you are covered under two dental benefits plans, notify
the administrator or carrier of your primary plan about your dual coverage
status. Plan benefits coordination can help protect your rights and
maximize your entitled benefits. In some cases you may be assured full
coverage where plan benefits overlap, and receive a benefit from one plan
where the other plan lists an exclusion. However, some insurance companies
refuse to coordinate benefits. Consult your providers or your insurance
contracts for clarification.
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Managed
care programs - Such as PPOs and HMOs, seek to control costs. The
means of controlling costs include “reducing reimbursement levels,
transferring the financial risk for the plan to the providers of care,
limiting access to care, and restricting the type, level and frequency of
authorized dental care,” according to the Jan. 23, 1995, ADA News.
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In
managed care – The PATIENT enjoys the lower costs for dental care. The
EMPLOYER provides their employees with dental insurance (at less cost to
the employer) The INSURANCE COMPANY still makes their same profit. The
DENTIST absorbs the loss by accepting lower fees.
However, the Dentist must somehow compensate for the loss. Practically all
loss is made up in quality of care. Lower quality, less expensive
materials are used. Less time is allowed per patient per procedure,
providing for "Minimally Acceptable Procedural Quality".
Treatment is significantly delayed or neglected all-together. Treatment
choices are limited to the lowest acceptable treatment option or the
"Least Expensive Alternative Treatment" (LEAT), dictated by
insurance coverage.
Our commitment to the highest quality dental care keeps us from
participating in managed care programs. See Our
Philosophy. Our fees are reflective of the level of Time, Care,
Skill, and Judgment, that it takes to perform treatment to
the very best that they can be done. The doctors participate in the
Highest Level of Continuing Education, use the most Modern
Equipment and Techniques available and ensure that only the Highest
Quality Materials are used. Shortcuts will obviously reflect in the
quality of the level of care that is received. It is certainly true, that
you can spend a lot of money and not receive anything of value, but it is
also true that something of high quality and value cannot be obtained for
nothing or next to nothing.
Before agreeing to participate in any managed care program, take some time
to educate yourself about the types of plans and agreements and their
benefits and drawbacks. For more information Click
on the links below for a guide to several types of dental insurance:
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Direct
Reimbursement
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Indemnity
or UCR (Usual, Customary and Reasonable)
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PPO
(Preferred Provider Organizations)
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Capitation
or HMO (Health Maintenance Organizations)
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