1. ARE YOU IN MY INSURANCE NETWORK?
- No. Dr. Young is an independent private dentist, not a contractor of any insurance companies.
2.DO YOU TAKE MY INSURANCE?
- It depends on the limitations set by your insurance company. We do not discriminate any dental benefit plans, but insurance companies write their policies to discourage
their buyers from going to an independent private dentist. The DHMO plans and State Medicaid Plans are perfect examples. For other plans such as PPO, you have more freedom to go to a contracted
dentist or a private dentist. As a courtesy, we contact your insurance company on your behalf to get a most essential information about your benefits and limitations. This information is then relayed
to you in plain English so no matter which dental office you choose to go, you will be armed with a better understanding of your plan.
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 any dental treatment procedure can be determined, a clinical dental exam, radiographic exam, your medical and dental health history are required.
That, along with digital photographs and its interpretation, the correct diagnosis of a dental problem can be made with certainty. A correct diagnosis eliminates unnecessary and least successsful
treatment options. Only the realistic treatment options that are most appropriate for the tooth or teeth in trouble are presented to the patient verbally with visual aid and on written document
to take home and review at leisure.
- For those with payment-assistant benefit 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.
3. IS THE AMOUNT INSURANCE COMPANY PROMISED TO PAY RELIABLE?
- NO. Unfortunately for the consumers and the dentists, insurance companies are LEGALLY EXEMPT from paying their share AFTER the dental care is provided.
There are several limitations* written into
the contracts they sell to the consumers and employers by their underwriters and legal team that allow the insurance companies to get out of paying for your treatment.
* HERE ARE SOME OF THE COMMON LIMITATIONS...
1. WHY DO I HAVE TO PAY WHEN I HAVE DENTAL INSURANCE?
- The one thing insurance
companies made clear when they sold their plans is that they will not pay 100% of every procedure and will not pay for every dental procedure no matter how crucial it is to keep your smile and
- So based on the rules and
limitations they draw up, insurance is actually not an insurance, but a dental benefit plan, It is only a form of financial assistance to help with the expense of your dental
- A few 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 to replace the missing tooth. 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 per calandar year. With the exception
of some plans, most dental benefit plans will pay for only 2 exams, one or two bitewing set of x-rays, and 2 cleanings per year. It does not mean you only need 2 exams. It
does not mean you are limited to 2 exams a year. There may be times where you need exams more than twice such as a dental emergency episode where exam is a must to avoid pulling the wrong tooth or
drilling the wrong tooth. However, if the insurance company sees that they already paid out for two exams for that calendar year, they will put the responsibility of the cost of the necessary exam
entirely on you.
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 dentists 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 secondary insurance annual benefits by the amount the primary insurance paid out toward the procedure. If you
have this type of secondary insurance, and you are paying for it each pay check, it is pretty useless. Before picking up an extra Insurance, you would want to ask how they coordinate benefits with
primary and secondary insurance plans.