We welcome patients
with dental insurance
We gladly accept insurance for our services, and are always ready to help you negotiate the insurance minefield. It's worth the effort, because for those fortunate enough to have coverage, it relieves the financial burden that often comes with quality care.
Insurance is a safety net
While insurance makes care more affordable, most plans cover only a portion of the cost. In order to keep premiums competitive, carriers may restrict benefits by limiting the number of covered procedures, by calculating benefits based on only a percentage of the actual fee, and by basing reimbursement on unrealistically low fee schedules.
Check-ups, x-rays, and cleanings are often covered at or close to 100%, but payment for other services may range from only 20% to 85% of the actual fee. Therefore, if you have insurance you might want to consider the following:
1. Higher reimbursement for preventive care can be a strong incentive to maintain your regular schedule of Dental Health Visits or "check-ups."
2. When more comprehensive care is necessary, insurance can give you the flexibility of financial freedom to be able to choose from among the best treatment options.
3. Annual eligibility cycles create recurring windows of opportunity to find ways to take maximum advantage of your available benefits.
4. Your access to care afforded by insurance motivates our office to offer you a variety of payment options.
5. While the cost of care is defrayed by insurance, there will still be a balance remaining that is your responsibility after benefits have been received.
Insurance can be confusing
There may be times when claims for what seem to be clearly covered procedures are rejected. When you have questions about denial of reimbursement for proposed treatment or for treatment already provided, or if you have other concerns about a service that you believe should be covered by hour dental benefits plan, we will be your advocate and will work with you to achieve a satisfactory resolution with your carrier. However, it is your responsibility to pay for treatment you have already received, even as we explore avenues of appeal.
Our helping hand
Since dental insurance rarely covers the total cost of care, we will help you understand the benefits your plan includes, excludes, or restricts and then work through the limitations as best we can. You may already have discovered that plan provisions often defy logic, which may lead to our mutual frustration with the carrier.
Preferred provider organizations
Insurance companies sometimes encourage dentists to join their network of "preferred providers" on the condition that their groups receive care at a discount. This puts pressure on the practice to figure out a way to reduce fees while maintaining quality. We believe everyone is entitled to be treated the same. For this reason, third-parties have been unsuccessful each time they petition us to provide an alternative discounted class of service for their patients. It would be impossible for us to compromise our standard of care without at the same time jeopardizing our integrity.
Washington Dental Service (W.D.S.) is prominent among those who aggressively recruit "preferred providers" but we are in a select group with about 300 of our colleagues who remain free of its influence.
W.D.S. still honors our claims, but when it calculates benefits, the net result is a greater out-of-pocket balance for our patients who have chosen our practice in a conscious decision to accept nothing less than the best.
Whether or not you are in a P.P.O., our patients realize that at The Center for Advanced Dentistry, we consistently deliver on our promise to provide uncompromising care at a fair fee. We hope your plan does not discriminate against you, but if it does, thank you for your unyielding commitment to quality dentistry.
Once in a while, we have a patient who is pressured to leave our practice because we are not a preferred provider. When they want to return, as they frequently do, we always welcome them back with open arms.
Discounts
For all our patients (including those who are members of a P.P.O.), we offer a discount for payment at the time of service. You always have the option to take advantage of this great savings opportunity.
Fees and "U.C.R."
Your benefits may be tied to a fee that has been unilaterally determined by your carrier, linking benefits to its own unrealistically low version of "usual, customary, and reasonable fees." Don't be misled by such insurance company jargon.
Elective Care
When you desire cosmetic dentistry that falls outside third-party reimbursement guidelines, we will still explore ways to secure a benefit for you.
Maximum Benefit
We are very good at monitoring plans to help our patients reduce their total out-of-pocket expense by taking advantage of all their benefits before the end of each twelve month cycle.
Pre-authorization
Before using your dental benefits, we can determine if services require prior approval.
Statement of services
If your plan allows you to file your own claims, you will receive a statement that clearly explains the treatment provided by our office.
Deductibles
Some plans have a deductible that is payable at the time of service.
Assignment of benefits
Benefits are generally assigned to our office. When they cover only a portion of the cost of care, our patients then receive a statement for the balance due. Remember, though, at the time of service you always have the option to pay at a discount that portion of the fee not covered by insurance. Since the law prohibits us from waiving any of the submitted fee, we cannot accept assignment of benefits that would preclude us from receiving full payment.
Eligibility
Benefits can generally be verified by our business staff when you come in for treatment. However, it is always a good idea to confirm beforehand your eligibility with your employer.
Assistance
We are accustomed to resolving our patients' concerns, and you should feel free to inquire about any matter relating to insurance.