Insurance/Payments
Insurance & Credit
Cards welcome.
Payments:
For
your convenience, our office accepts Visa & MasterCard.
We are also willing to work with you to develop a payment
plan to
fit our mutual needs.
 
Insurance:
Unlike
most common types of insurance which protect consumers
from unexpected
events, dental insurance is designed to help
individuals by paying for a portion of the cost of
their dental care. For that reason dental insurance plans
are
frequently
called dental benefit plans and are usually the result
of contract
between the plan sponsor (your employer or union)
and the third party (insurance company). Extend of coverage
and various
limitations
are the result of the financial commitment the plan
sponsor has agreed to make and the benefits the third-party
payer
will offer in exchange for that commitment.
There are four most common types of dental benefit plans available
today:
Traditional Indemnity:
This is what most people assume when they think of insurance.
Unfortunately, due to the high cost of healthcare, this type
of coverage is becoming less prevalent.
With traditional indemnity, you can go to any dentist you
want, as long as the dentist accepts your insurance. You usually
have to pay an annual deductible. A deductible is a minimum
amount that you have to pay out of your pocket before the insurance
will start to provide coverage. The same is true for specialists.
You also pay a copayment. A copayment is the portion of the
fees that the insurance company expects you to pay. If your
insurance covers 100% of the fees, your copayment is zero.
If the coverage is 80%, you have to pay 20% and so forth.
Traditional indemnity is very expensive and risky for most
employers and insurance companies, so insurance companies developed
various limitation that determine how much dental work you
are allowed in a year and how frequently a particular procedure
will be covered.
Preferred Provider Organizations (PPOs):
Another common type of dental insurance is generally referred
to as Preferred Provider Organizations (PPOs). It is a modification
of traditional indemnity. The insurance company contracts with
independent dentists, to provide dental care at a fixed contracted
price (usually lower fees than normal). In return, the dentist
is listed in a provider list. The dentist is reimbursed in
a manner similar to traditional indemnity, but at a lower fee.
As with traditional indemnity, your coverage is subject to
deductible, copayment and plan limitations. You also have the
option of going to any dentist you choose but will receive
lesser benefits if the dentist is not contracted as provider.
Health Maintenance Organizations (HMOs
or DMOs):
This type of dental benefit is the least expensive and least
risky alternative for your employer. The dentist is generally
paid a fixed monthly amount per patient or family enrolled
in the plan (called a capitation), and all other amounts are
paid by the patient.
As with PPOs, the dentist contracts with the plan company
(technically, HMOs are not insurance), for a reduced fee; these
fees are significantly less than usual (many times zero or
near zero). However, unlike traditional indemnity or PPOs,
the plan company does not pay for any of these fees; the patient
pays 100% of these charges.
With an HMO plan, you usually do not have the option to go
to a dentist not on the provider list with exception of emergencies.
Additionally, you cannot go to a specialist until you get a
referral from your primary dentist.
For procedures not covered, the patient is required to pay
the normal fees charged by the dentist or choose a less expensive
alternative from the approved procedure list (if one exits).
Denti-Cal:
Denti-Cal is the State of California's version of the dental
portion of Medicare and Medicaid. Denti-Cal contracts with
dental offices to provide dental services for a reduced fee
determined by Denti-Cal. Patients with Denti-Cal can only go
to the dentist who has a contract with Denti-Cal but Denti-Cal
pays 100 % of the fee. Denti-Cal requires that most major procedures
are pre-approved before they are performed and can deny approval
for a variety of reasons.
Some employers now offer more than one dental plan to their
employees. To understand and make decisions about your dental
benefits, it is important to remember that plans are often
very different. To make the best decision for you and your
family, you should understand exactly how the different kinds
of dental benefit plans work. Your dentist may be able to help
you decide on the best dental plan to suit your dental health
needs.
In an effort
to make our services accessible to everyone in our community,
our office has contracted with many dental benefit
plans. Call us to find out if we accept your dental benefit
plan. If we are not currently a preferred provider for your
plan, we will be happy to review the plan details and possibly
join the network to accommodate your dental health needs. Please
keep in mind, that some dental plans are designed to serve
the interests of the insurance company rather than the patient
and prevent you from getting the best dentistry you deserve.
Our office chooses not to sign up with any plan that, in our
opinion, does not provide adequate coverage for our patients.
If you would like more information about your particular plan,
we would be more than happy to assist you in any way we can.
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