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Fees & Insurance

Medical and Dental Insurance can drive you crazy. I recount one story about how in 40 minutes on the telephone, I went around the world (Mauritius —> Phillipines—> Oxnard, CA —> Maine) to only find out that the employee was not covered by this plan!

We will gladly fill out and submit your dental insurance forms. Don’t expect your insurance to cover everything though.

 

It is common to encounter:

  • Deductibles – you have to pay for the first x amount of $$ in a calendar year.
  • Exclusions – Insurance companies don’t wish to cover certain procedures.
  • Plan Maximums – They’ll only cover X amount $ in a calendar year
  • Downcoding – The company will only pay for a cheaper procedure (ie) a metal crown and not a white porcelain one; a silver filling and not a white filing)
  • Plan Limitations – If my office doesn’t participate with your plan, they may not pay as much (this is frequently just a small amount, but the insurance companies usually won’t tell you in advance)

Then there are various programs:

  • A DMO (like an HMO) will only allow you to go to providers on the plan. I do not participate in any of these. A DMO may cost you more than no insurance at all.
  • A PPO (preferred provider organization) generally allows you to go to any dentist you want, but the warning is, if the dentist is not a participating member, you will likely have some out of pocket expense. Our office participates with Anthem (Blue Cross), but not wilh Delta or Metlife. If you have either of those, you can still see me, but there may be a a co-pay involved.
  • Indemnity plans – are generally traditional benefit plans where you can see any dentist.

I am sure that you now realize that Insurance companies may be more concerned with their financial bottom line than your health. Our business is your health and this is how we make mutual decisions with you concerning treatment.