Park
Cities Dental
"The
Art and Science of a Healthy Smile"
TO OUR PATIENTS: During the past two decades,
dental benefits plans have become an integral part of health care planning
for many families. Dental benefits plans are made available to employees
or members, through companies, unions, and associations, and may vary considerably
from one plan to the next. The range of benefits depends solely on what
the plan purchaser wishes to offer employees or members. Some plans may
cover as little as 30% or as much as 100% of dental services, with most
falling in the 50% to 80% range. Some plans exclude certain types of services,
e. g., orthodontics, while other plans will cover a full range of dental
services. Some plans base the amount of benefit on a chart or schedule
of fees arbitrarily developed by third-party payers. For this reason, you
may receive a lower percentage of the reimbursement level indicated in
your dental plan. For example, if your plan states that it will pay 80%
of the cost of dental treatment, it means 80% of the fee as determined
by the insurance company, and not the actual fee charged by me. As the
number of patients covered by dental benefits plans has increased, certain
assumptions have become evident and we would like to make the principles
of our practice, as well as the type of service and care we provide our patients,
very clear: Our fees are based on the overhead involved in the practice,
the treatment plan selected, and the time it takes to provide you with
the necessary dental care. We do not believe it is in either of our best
interests to compromise recommended treatment in order to accommodate
a dental plan's maximum benefits that may be considerably less than optimal.
However, we are more than happy to discuss a treatment plan's advantages and disadvantages with you thereby involving you, not the third-party payer in the decision-making process.
The type of treatment you need and receive from us is based upon our professional judgment, and not on whether you are covered by a dental benefits plan. As a courtesy to you, my staff will complete the dental portion of the claim form. To expedite processing, make sure that your part of the form is filled out completely and accurately. If you direct the insurance company to pay its share of the cost directly to my office, you will receive credit for this amount and be billed for the balance. Upon receipt of payment from the third-party, my staff will reconcile the amount and bill, or refund, any difference. If your dental benefits plan requires a predetermination or prior authorization, we will submit a treatment plan for review by the third-party payer. However, please remember that the financial obligation for dental treatment is between you and this office. The third-party payer is responsible to you and not to this office. If you receive a communication from the third-party payer suggesting that our fee varies from what they allow for the services provided to you, please do not accept this as fact without first discussing the matter with us. The third-party payer's fee data may be extremely out of date. It may not take into consideration local factors pertaining to Dallas County in establishing its schedule, and its geographic area may not be germane. If, after our discussion, you believe that the dental benefits provided by your plan are inadequate, you may want to discuss the matter with your employer, union, or association, so that appropriate alternatives can be investigated. If the red tape and lack of control that the insurance companies put between you and the proper care that you and your family need bothers you, you can get more information about alternatives. Call the Dallas County Dental Society go to the American Dental Association's site to learn more about Direct Reimbursement. This is a means of putting more of the money your employer spends on benefit plans into care for you and less into the pockets of the insurance companies. It costs your employer less... and you get more. We will help you in every way in filing your claims, handling insurance queries, processing follow-ups, lost claims, etc. No question is too small for you to ask, whether it is about your treatment, benefit plan, or statement. Stop in, or call, any time you have a question. We are here to help you.
Return to Facts about Dentistry and Services
Send comments to: Dr. J. Eric Hibbs