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If you do not have dental insurance, you are encouraged and welcome here as part of our patient family. It may interest you to know that in some instances patients have found it cheaper to save their premium dollars and pay for needed dental work themselves. For example: dental insurance with an annual benefits cap of $1,000 is it worth spending $950 out of your paycheck to get this money? Dentists can choose not to work for the insurance companies. In my office, we work %100 for you. We do not want you or your treatment to be controlled by insurance; we have enough of it in medicine already!
A dental insurance plan is a contract between you and an insurance company that, in most cases, is coordinated by your emplyer. If that's the case, the insurance company and your emplyer are responsible for negotiating the details of the plan. Because our office has no control over this contract, we cannot request additional coverage for you.
In direct reimbursement programs, your employer reimburses you directly for part or all of your dental treatment. All procedures and treatment methods are usually covered, and you can see any dentist you choose.
In a preferred provider organization, you must choose from a group of dentists who have agreed to discount their fees so that they can be a part of the organization.
In a capitation plans (also called a dental health maintenance program), participating dentists are paid a set amount for each patient enrolled in the plan. Dentists are paid this set amount no matter how often you visit them (or don't visit them) and no matter what kind of treatment you get. This generally means that the more work these dentists do for their patients, the less money they'll make.
The most common insurance programs are indemnity plans, which are also called UCR programs. UCR stands for "usual, customary & reasonable." In these plans, you may choose any dentist and pay on a traditional fee-for-service basis. The insurance company, who is paid a monthly premium by your employer, then reimburses you for between 50% and 80% of the dentist's fee. You are responsible for the remaining 20% to 50% after meeting a pre-determined deductible payment. The amount of the deductible is set in the contract between your emplyer and the insurance company.
Referring to the program and its fees as "usual, customary, and reasonable" is misleading. Most people assume that insurance companies have gathered statistics and that these statistics are the basis for UCR fees. This is simply not true in many cases. These UCR fees often do not represent local dentists' fees or the available treatment options. They may be, in fact, simply fees that are set by the insurance company. As a result, different insurance companies often have different UCR fees for the same geographic area and for the same group of dentists!
We ask that you understand that we neither work for the insurance companies, nor do we wish to. We work 100% for you. We want to help you maximize your benefits, but also we do not want to be controlled by insurance companies or the benefit packages they offer. It is unrealistic to expect that years of neglect can be “made up” by a year or two of “insurance coverage”.
If you were to build a house, would you rather have the least expensive contractor who used the cheapest materials and technologies? Or would you rather build a home that will last using quality materials?
You have similar choices when it comes to your dental care. In many cases, your insurance company wants you to consider only the cheapest dental procedures, but we believe that you should be able to choose the best dental treatment and materials for you and your family.
Joel C. Scalera D.D.S., P.A. © Copyright 2016. All Rights Reserved.