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Posted on: September 24, 2008
The Insurance Question
Many people contact us with dental needs and questions about insurance. For us the answers are fairly simple and straightforward, but I realize that dental insurance may be confusing for many, so I want to address it here.
Our office provides exceptional dentistry based on first establishing a relationship with our patients. Dental insurance companies are unlike us and most businesses in that they don’t want a relationship with their customers and hope their customers never use their product. Only rarely do they ever meet their customers, yet they will expect their customers to have them approve very personal decisions about their dental care. In fact, they do whatever they can to ensure that their product is difficult to use. They limit what they cover and prolong the reimbursement process with unnecessary paperwork.
For many years, I participated with a limited number of insurance companies. Over time, however, I realized that I could not in good conscience permit a third party insurance company to dictate the quality, timing or cost of the care my patients receive. I no longer participate with any insurance companies as a Preferred Provider (PPO) or otherwise, but we do regularly assist our patients in receiving their insurance benefits. Much of what we do for our patients is covered by insurance. Many people don’t understand that their insurance policies do not require them to go to a participating or Preferred Provider (PPO) in order to receive benefits. The reality is that patients who go “out of network” are still entitled to benefits. The difference is that a PPO is limited as to what procedures and charges are permissible for a given condition, whereas an “out of network” provider is unfettered by third party insurance dictates as to the appropriate treatment for a condition.
The bottom line is that most insurance policies will pay for $1000 of dental treatment no matter who the provider is. Why have that work done by a provider who may be more interested in complying with insurance company rules and guidelines than in what you want and need? My priority is what my patients want and need. My goal is to ensure that my patients have the healthiest most natural smiles they can have.