Does your office take my dental insurance?


This is a question that is asked by most patients calling whom have dental insurance. Many patients aren't that familiar with the exact plan they have.

When we ask them  about it, they often reply with the company name... I have Cigna, Delta, Aetna, United Healthcare, etc.. The problem that this presents for us is that we may participate with Cigna PPO dental insurance but we are not "officially" accepting Cigna Advantage PPO dental insurance ( a less expensive plan that Cigna seems to market aggressively to employers.

The fact is that while we accept most dental insurance plans, we often out of network. we "balance bill" patients the difference between what their insurance pays and our actual fees. For many patients with good PPO plans the difference can be minimal. Insurance companies have their own rules and they maintain that forgiving co-pays is illegal and constitutes insurance fraud. Although their are dental practices that do not collect co-pays from their patients, our practice plays by the rules.

After a patients cleaning we perform an examination and if a patient needs non further treatments, usually we recommend sending in a pre-certification. This results in the  insurance company returning  an explanation of their payments for proposed treatments and allows a patient to see what their out of pocket costs will be.

Why do we not participate with more plans? We limit participation because we strive to perform our dentistry to consistently high standard and it is our belief that accepting significantly lower fees might tend to change the way we perform our dentistry and could compromise the quality of our care.

My decision does not imply a blanket condemnation of "insurance dentists" since they are well trained and are often quite knowledgable. They strive to provide the best dentistry that they can, while still generating a profit. For them to succeed in this goal, they face a considerable pressure to complete more dentistry in relatively short amount of time (as compared with my schedule).  I have experience working  in  settings where most insurance plans were accepted and have found that care could be negatively affected, since shorter amounts of treatment time were scheduled and less expensive dental laboratories were used.

I truly enjoy providing  high quality care for my patients in an environment where the  amount of time spent with each patient is not the number one concern. I actually try not to look at the clock, but instead focus on the procedures I am performing in order to ensure that they are done in a manner that will produce the best result.  If I am taking impressions for a crown, I have the luxury of taking a second or even third one if the first one doesn't seem optimal.

Although for many , going to a dentist that accepts their plan is their first consideration when choosing a dentist, it needn't be true for all, since their primary goal is to preserve their teeth. After all our teeth do not grow back, once they are removed but if properly cared for they may last a lifetime without any need for multiple replacements!




from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2020/08/does-your-office-take-my-dental.html - http://lspindelnycdds.blogspot.com/

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