Michael S. McCann, D.D.S., P.C.
Dental Benefits
Dental Benefits Clarification
A common question asked of our office is “Do you take (this or that) insurance?” Our answer to that question is that we do not “take” any insurance. We want to work for you, not the insurance industry. We want your treatment to be based on your desires and needs, not driven by your insurance plan.
We do not accept insurance as a form of payment. Our contract for services is with you, the patient, and not with an insurance company. What we can do, as a service to you, is to help you maximize the benefits you may receive through an insurance carrier. We are happy to provide the necessary claim forms to send to your primary insurance carrier which lessens your personal paperwork.
Patients with dental insurance coverage need to remember that professional services are rendered and charged to the patient and not to any outside party. We provide our services for you without regard for the services that an insurance carrier might or might not cover. This is because we care about you and your health. We can only recommend treatment based upon the need of each individual patient. Treatment is recommended and options are discussed with you so that you are in control of your own health.
We have many payment options available for our patients. If you wish to discuss these options, we will be glad to do so once your treatment plan has been finalized. Full payment for services rendered will be expected at the time of service unless you have made a prior financial arrangement with us. We can also assist you in exploring the possibilities of outside financing for your dental needs.
Our office cannot accept responsibility for collecting insurance benefits or for negotiating a settlement on a disputed claim with a patient’s carrier. However, again, we are happy to assist and do everything within our power to help you receive the maximum benefits allowable under your policy. Many times, we call the carrier, write narratives to explain procedures that were performed, and “go to bat” in general for our patients. The bottom line is that the patient is responsible for payment of his/her account within the limits of our financial policy. Fee assistance from insurance carriers is determined by the insurance plan which is usually chosen by an employer.
We hope this clarifies some of the most frequently misunderstood ideas regarding dental insurance. If you have any questions about our financial arrangements or other questions regarding insurance, we are happy to assist you.
Facts Regarding Dental Benefits
Dental insurance benefits are rapidly playing a larger role in helping people obtain dental treatment. Dentistry is different from medicine and dental benefits are different from medical insurance benefits. Dental insurance is really a misnomer. Dental benefit or fee assistance are more appropriate terms.
Since we strongly feel our patients deserve the best possible dental care we can provide, and to maintain this high quality of care, we would like to share some facts with you about dental insurance.
FACT #1: Dental insurance is not meant to be a PAY-ALL. It is merely an aid or fee assistance.
FACT #2: Each subscriber (or patient) is responsible to know the coverage of his/her own dental insurance plan. There are just about as many plans as there are employers, so plans vary widely, and employers generally supply each employee with a packet containing the coverage information. Before any dental work is contracted to begin, it is wise to know your own coverage limitations. By making a phone call to your carrier, or by looking up the information in your insurance packet, you can obtain the information needed prior to contracting for any dental services.
FACT #3: Many plans tell their insured (subscriber) that they will be covered “up to 80% or up to 100%” for many preventive and diagnostic procedures. We have found that most plans cover less than the average fee. Some plans pay more, some less. The amount your plan pays is determined by how much your employer paid for the plan. The less the employer paid for the insurance, the less benefit or fee assistance you will receive.
FACT #4: It has been the experience of many dentists that some insurance companies tell their customers that “fees are above the usual and customary fees in your area” rather than saying to them that “the insurance company benefits are low”. Remember, you will only get back in a benefit what your employer puts in, less the profits and administrative costs of the insurance company.
FACT #5: Many routine dental services are NOT COVERED by insurance plans and some plans will cover services once each year, but not two times, e.g. fluoride treatments. Some companies cover diagnostic models, others only cover models for orthodontic patients, etc., so knowing your own plan will help you in your decision processes and with your financial responsibilities.
Please feel free to ask us any questions you may have about these issues. We want you to be comfortable in dealing with insurance matters and we urge you to consult us if you have any questions regarding our services and the fees charged for those services. We will always help you with collecting your benefits for our services rendered. If we take assignment on your insurance, that is considered a “loan” and we feel that 60 days is a reasonable length of time for us to wait for payment from your insurance company. Please remember, the services we provide are for you and our agreement for payment for our services is with you, not with your insurance company.
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