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Insurance Information
Due to much confusion
surrounding Dental Insurance, we would like to help our
patients understand their options. Our office accepts
coverage from all insurance companies
(i.e. Aetna, Delta, CompDent, MetLife, etc.);
however, we do not accept all of the different types of
coverage that these companies
provide. The following is a brief overview of the
different types of dental coverage or
policies that the insurance companies
offer.
Note: Almost all insurance
policies have both a deductible and an annual maximum
associated with them. The deductible is typically in
the range of $25-100 and is not usually applied towards
recall hygiene visits. The annual maximum is typically
between $1,000-$2,000 and does include recall hygiene
visits. This total yearly maximum has changed very
little over the last 40 years. This is both good news
and bad news, since this has kept Dental Insurance
affordable as compared with Medical Insurance-- but it
also means that it does not cover as much today as it
did year's ago.
It is also important
to note that all insurance policies that we accept
pay a percentage of what they deem UCR, or usual,
customary, and reasonable. Unfortunately, the
insurance company’s definition of UCR does not
always correspond to the existing average procedure
fees for the Medina area. The following is just an
example of what you can expect from your PPO or Fee
for Service Coverage (in addition to the deductible-
if restorative work is needed):
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80-100%
of your recall
hygiene and x-ray procedures
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60-80%
of your
restorative work (fillings, extractions,
root canals)
-
40-50%
of crowns done
in office or anything that needs to be sent
to a dental lab (crowns, bridges, dentures,
etc.)
If you have any questions
about your specific insurance coverage, please
contact your insurance company. |
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1. DMO / HMO Coverage:
This is a managed-care insurance plan that requires the patient
to visit a dentist who has signed a contract with the carrier
for this type of coverage. Although this coverage is often the
most affordable for your employer to purchase, it forces the
patient to choose from a very small list of dentists. The list
of dentists is short because the compensation for the dental
office is so poor that it often does not cover expenses for
optimal dental treatment. Our office does NOT accept this type
of insurance.
2. PPO (Preferred
Provider) Coverage: This is currently the most common
of the insurance policies. It is important to note that there
are two types of PPO’s. The first allows you to “go outside the
network” and therefore see any dentist you wish; and the other
does not allow you to go outside the network. We are not
included in any PPO plan directly, so if your coverage does not
allow you to “go outside the network” then we cannot accept your
insurance. However, much more commonly, PPO’s will
allow their clients to see whomever they choose (go outside the
network). 70% of our patients have chosen to go
outside their network. Note that when you do go outside the
network, the insurance company states that you will have to pay
more than if you stay in the network. Our experience has shown
that these patients often pay the same amount for recall hygiene
visits, and just 5-10% more for restorative visits when compared
to patients who stay within their network.
3. Fee for Service
Coverage: This is the traditional type of insurance
policy that allows their clients to see any dental office they
wish and pays a specific percentage of dental work.
Unfortunately, this type of insurance is not always offered to
employees, or often is the most expensive of the employee’s
choices.
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The
American Dental Association has a lot of
information regarding dental insurance and dental benefits that many
patients find helpful. |
330-721-0606
