Insurance
Our office is a fee-for-service dental office. We prefer to remain independent and do not belong to any dental plans. We are not on any participating list of dentists. Prior to starting treatment, it is always important to acquaint yourself with the nature of your coverage; the dollar amount of your annual maximum benefit or remaining calendar year benefit; and the amount of your deductible.
We do not accept insurance assignment. Our office, as a courtesy, will submit your dental claim to your primary insurance carrier with all of the supportive documentation required for payment of your benefits directly to you. Every insurance claim, no matter how simple, requires approximately 30 minutes to process. Our insurance coordinator will record and itemize each service, print the claim, duplicate any x-rays, copy periodontal charting, document every transaction in your chart, and send each claim (by mail or electronic submission). Each and every claim is carefully reviewed, prior to submission, to insure that all information required for timely determination of benefits by your carrier is included. This procedure is important to facilitate a well-timed turn around of reimbursement to you, the patient. It keeps fees at an appropriate level, and also prevents having to submit the same claim twice.
Facts You Should Know About Dental Insurance
Dental insurance plays an important role in helping people obtain dental treatment. Since we strongly feel our patients deserve the best possible dental care we can provide, we would like to share some facts about dental insurance with you.
Fact 1
You may receive an explanation of dental benefits (EOB) from your insurance company stating that dental fees are higher than the usual and customary dental fees. An insurance company surveys a geographic area, finds the average, then takes 90% of that fee and considers it the customary fee. Additionally, insurance companies only perform this survey once every 5 - 7 years, as it remains a costly exercise for them. The coverage does not keep up with the costs that quality dentistry faces today.
Fact 2
Dental insurance is not designed to be a PAY-FOR-ALL. It is only meant to be an aid.
Fact 3
Many plans tell their insured that they will be covered "up to 80%" or "up to 100%," but do not clearly specify plan fee schedule allowances, annual maximums or limitations. We have found that most plans cover about 35% to 65% of major services based on the plan's pre-established maximum fee allowance, which varies from carrier to carrier.
Fact 4
It has been the experience of many dentists that some insurance companies tell their insured that "fees are above the usual and customary fee" rather than saying "our benefits are below what is normal and reasonable." The amount your plan pays is determined by how much was paid for the plan. The less paid in premiums for the insurance, the less you will receive in benefits. Remember, you get back only the premiums paid into the plans less approximately 30% in insurance company "administrative costs." The insurance companies’ goal is to make money, period. Their desire is to minimize payments and to have you wait an extraordinary amount of time for reimbursement so that they can use "your" money. The quality of care you receive is not a priority for them.
Fact 5
Many routine dental services are NOT covered by insurance carriers.
Fact 6
During the last six months of the calendar year, we would like to remind each of our patients to optimize their insurance benefits before the New Year begins and brings a new deductible. Numerous patients also enjoy the benefits of flexible spending accounts, which also need to be utilized prior to the end of the calendar year before benefits are lost. If you have any unused benefits and are due for an examination or treatment that may have been delayed, please call the office to schedule an appointment. We want your final out-of-pocket expenses kept to a minimum and your New Year to start out happy and healthy!
Please do not hesitate to ask us any questions. We want you to be comfortable in dealing with these matters, and we urge you to consult us regarding our services and fees. We will do all we can to guide you through obtaining your maximum benefits.
If you have any specific questions regarding your insurance, we ask that you contact your company regarding any details of the plan.
Dr. Harold H. Fagan and Staff