1. ARE YOU IN MY INSURANCE NETWORK?
- No. To be in a network with an insurance company, the dentist must sign a contract with insurance where the dentist becomes a contractor to the insurance
2.DO YOU TAKE MY INSURANCE?
- A dental office can accept dental insurance as a form of payment, such as food stamps in the grocery stores, even though the office may not be contracted
with a particular insurance.
- We limit to accepting PPO insurance benefit plans that pay for the dental care at their actual cost, because they have the least nasty surprises and hidden rules. In addition,
we are finding that the quality and limitations of your plan is more dependent on your employer than insurance companies. We offer the free service of checking the rules nd quality of your plan
on your behalf before we can say yes or no.
- We do NOT accept State Medicaid and its affiliated plans, such as NJ Family Care, Union Plans, Delta Dental, Horizon, or Blue Cross Blue Shields.
3 .HOW MUCH IS MY TREATMENT?
- The cost for treatment is the same whether you are an independent self-paying patient or has a payment assistance plan through an insurance
- However, before the cost of the dental treatment procedure can be determined, a clinical dental exam, radiographic exam, your medical and dental health history are needed. Only
with those information, along with digital photographs, a correct diagnosis of the dental problem can be made, and determine the type of treatment options based on the diagnosis. Treatment options
are then presented in writing for the patient to take home and think over.
- For those with payment-assisted plans from insurance companies, We ALWAYS submit pretreatment estimate request to your insurance
company prior to beginning any dental treatment. Your company will send back what they INTEND to pay and your
anticipated share of the cost of your dental care. As I take my time to thoroughly examine each patient and dental problem, I do not accept a large group of patients.
3. IS THE AMOUNT INSURANCE COMPANY PROMISED TO PAY RELIABLE?
- NO. Insurance companies are LEGALLY EXEMPT from paying their share at the last minute AFTER the dental care is provided. There are several limitations* that their lawyers wrote these exemptions
for the insurance companies in the contracts that you or your employer sign when you give them money to purchase an “insurance.” You always find out about this only when you use the benefit
plan you paid for.
* HERE ARE SOME OF THE COMMON LIMITATIONS...
1. WHY DO I HAVE TO PAY WHEN I HAVE DENTAL INSURANCE?
- Dental insurance is actually
not an insuirance, but a dental benefit plan. Also, it is only a form of financeial assistance to help with the expense of dental care.
- Some plans require that annual
deductibles is paid by you first to get the benefit of the dental insurance plan you bought.
- Dental benefit plans usually
pay 80%-100% of preventive care such as dental exams, dental x-rays, dental cleanings, and dental sealants. However, if you have a dental problem, such as a cavity or missing teeth, your plan
will only pay 50-80% of the cost. This is called the co-insurance or co-payment for the treatment procedures. The cost of treatment that is outstanding after your insurance company pays
is still your responsibility.
- Dental benefit plans usually
have limitations such as how often the insurance company will pay for common procedures, such as dental examination, dental x-rays, dental cleanings. Older dental benefit plans will pay
for only 2 exams, 2 x-rays, and 2 cleanings per year. It does not mean you only need 2 exams. There may be times where you need exams more than twice such as going to a specialist for a
consultation. However, if the insurance company sees that they already paid out for two exams, they will put the responsibility of the cost of the exam entirely on
2. WHAT IS THE DIFFERENCE BETWEEN A DISCOUNT
PLAN AND DENTAL INSURANCE OFFERED BY THE INSURANCE COMPANIES?
- DISCOUNT PLANS only came into
the market in 2013. This is the type of the plan was first created by insurance companies where they make you pay the insurance company to get a list of their contracted netowrk dentistists where you can get dental treatment for a “lower” fee. The subscriber pays for all dental
treatments, including dental exams and dental cleanings, to the insurance dentist at the time of the visit. For those treatments that are not negotiated by the insurance company with their contracted
dentists, you will be responsible for the dentist's full fee. With discount plans, insurance company does not pay anything toward your treatment as it would if it was a true dental insurance
- With the “true” “dental
insurance” benefit plan, there is a portion of money the insurance has to pay out each time you use your plan, because that was how the contracts begun decades ago as far back as 1950s. The insurance
collects money from you each month. In return, they give you a specific dollar figure they will pay out for your dental care expenses per year. Typically it started as $1,500 per year. About 60 years
later, this amount remained the same while the premium you pay to purchase increased. Living expenses and inflation increased. In addition, insurance companies found a way to legally decrease their
pay out by coming up with their own maximum reimbursement schedule regardless of what the true cost of dental care in the real world is where inflation, increased cost of living, etc.
3. I HAVE TWO DENTAL INSURANCES, DO I STILL
HAVE T0 PAY OUT-OF-POCKET?
- If you have two dental insurance,
it does not mean you have no out-of-pocket expense. On the contrary, you still have out-of-pocket expense 99.99% of the time after the secondary insurance pays out. There are times when
the secondary insurance will pay nothing out on your treatment but reduces your annual benefit with the secondary insurance by the amount the primary insurance paid