PREMIER DENTAL N EWS L E T T E R
5 Facts About Dental Insurance and How We Can Help You CARE YOU DESERVE
VISIT OUR OFFICE AT: 321 FARNSWORTH AVENUE, BORDENTOWN, NJ 08505 609.298.1124 OFFICE STAFF: PATIENT COORDINATORS MICHELE JOHANNA DENTAL ASSISTANT CATHLEEN
Patients rely on their insurance to pay for treatment, and at Premier Dental, we never want someone to avoid treatment because they can’t afford it. Because the dental insurance landscape is constantly changing, our office is always ready to take on the changes and challenges for a patient. Unfortunately, nothing confuses patients more than insurance, so we thought we would share some of our expertise with the following five facts about dental insurance. 1. Dental Deficit Dental plans in 1960 covered an annual maximumof $1,000, and if this figure were to be adjusted for the cost of living today, that maximumwould be around $4,000– $5,000. Yet, the standard dental insurance plan today is maxed at $1,000–$1,500. Adjusted for inflation, that’s less than one-third of what was typically covered 60 years ago. 2. Inflated Costs Unlike medical insurance, which often pays a large portion of your bill after your deductible is met, dental insurance does not pay for the full price of major procedures, even after youmeet your deductible. In fact, some major procedures, like crowns, are usually paid at only 50 percent. 3. Downgrades Insurance companies will often downgrade or apply an“alternate benefit”to a procedure in order to pay less. For example, insurance will only pay for metal or amalgam fillings. However, most patients don’t want metal in their mouths, and most dentists haven’t done an amalgam filling in decades. Instead, most people want a white filling so the color variation is minimal. We want to provide you with quality dentistry, but insurance companies will often only pay for the cheapest options. 4. Changes ... Again Did you know that there are more than 350 dental insurance codes for procedures, and that every year some of these codes change? Premier Dental and other dental offices receive a list of the new codes from the American Dental Association each year. Sometimes these changes are minimal, and other years we have to adjust 10 or 15 codes. Because of this, we
have to be vigilant and prepared. We compile and submit claims electronically to your insurance with the correct codes, along with any necessary narratives and X-rays, to get payment released from the insurance company.
5. Fee Predicaments The usual, customary, and reasonable fee (UCR) is meant to be a“fair”fee for a particular procedure within a
• 1 WWW.BORDENTOWNDENTIST.COM One of the biggest deterrents to completing treatment is affordability. Patients hope to be able to afford treatments at a later date, but in our professional experience, this stalling only allows a problem to fester and become more expensive. Don’t put off treatment because you can’t afford it. Please let us know howwe can help you and your family. —Peter Gopal specific zip code, but no two insurance companies can agree on what the UCR should be for procedures. Additionally, insurance companies do not tell the provider’s office what the UCR is, and some insurance companies lowball the UCR to pay out less. Since there is no transparency on the UCR, it is difficult to accurately calculate a patient’s portion of the payment. So, what we provide is a good faith estimate. As difficult as working with insurance is, we realize it is a very important benefit for you, and we will work with you and your insurance so you are able to take full advantage of your dental insurance. If there is a change in your insurance, provide us with your carrier’s name and group identification number, and we can take it from there. Premier Dental has significant expertise in this area, along with a diligent staff to help you. If you don’t have dental insurance, we also have an in-office savings plan.
CHARLENE LORI PRACTICE MANAGER PETER
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