About Your Insurance

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We are always available to speak with you to answer questions, address your concerns or schedule an appointment. Please feel free to contact us through our office phone numbers or e-mail address. After hours, you may contact us through our answering service.

Dental benefits are an important part of healthcare planning. We want each patient to have a good understanding of the insurance programs currently available so they can make the best decision about their dental care.

Indemnity or UCR Dental Insurance

v-smile4Indemnity or Usual, Customary and Reasonable (UCR) plans are the most common insurance programs. With these programs, you can select the dentist of your choice. The dentist is paid on a "fee for service" basis. Employers pay monthly premiums to the insurance company. Typically, indemnity plans pay for services based upon a variety of fee schedules. These plans usually have a deductible that is pre-determined, which must be paid before the insurance company starts paying for care. When the deductible is met, the insurance company pays 50 to 80% of the UCR fees, which means the patient must pay 20 to 50% or more of the total fee.

Often UCR rates are not representative of the local dental office fees. In general, insurance carriers set UCR fees way below the area dentists’ professional fees, leaving patients responsible for more "out-of-pocket" costs.

Every UCR plan has exemptions and limitations. For the most part, your contract covers only lower quality services and materials, which may not be the best treatment you or your family needs. All UCR programs have a yearly maximum allowable benefit. Sadly, this hasn't changed in 40 years. In 1970, the maximum allowable benefit was $1,000. Today, it still sits at about $1,000, in spite of rising costs. To keep up with the rising costs, that $1,000 would need to increase to roughly $7,000.

Unfortunately, although treatment costs and premiums continue to increase, insurance benefits have remained the same. Most plans often exclude newer treatments, and even common procedures, like implants and veneers. We believe each patient should be able to select the best treatment and materials.

Capitation or HMO Dental Plans

Capitation or HMO dental plans are another type of managed care. Instead of being paid for actual treatment, participating providers are paid a set amount for each patient enrolled in the plan. HMO plans often promote significant treatment delays, minimal services and the use of low quality materials.

Participating providers lose money each time they see a patient or perform a procedure. So, their best option is to delay treatment or only offer the least expensive procedures. Patients enrolled in HMO plans can only see participating providers. If the dentist is not an HMO provider, the patient is responsible for all charges.

Our office has never participated in any HMO plans due to the nature of these plans discouraging treatment planning in the patient's best interest. Our primary concern has always been patient care first. Any interference or influence by a third party in treatment planning presents an ethical conundrum that we feel has no place in the doctor-patient relationship.

Prior to treatment, it is always best for you to contact your insurance company and confirm your benefits and coverage. We will assist you with any questions or concerns you may have.