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Our primary objective is to provide high-quality dental care at a fair fee while the insurance company's primary objective is to earn a profit for its shareholders.  Yes, we are in business to earn a profit too, but we cannot allow the insurance company to dictate the standard and quality of care delivered to you.  In recent years, our office has experienced mounting "ill will" as a result of being caught in the middle between the insurance company and our patients. In an effort to maintain a high quality of care, we would like to share some information about dental insurance with you.

 A common point of confusion is about how an insurance company determines UCR (Usual and Customary).  Inflammatory information is often sent by the insurance companies which may state our fees are higher than usual and customary.  An insurance company surveys a geographic area, calculates an average fee, takes 80% of that fee and considers it customary.  Included in this survey are discount dental clinics and managed care facilities, which bring down the average.  Many plans tell their participants that they will be covered "up to 80 percent or up to 100 percent," but do not clearly specify plan fee-schedule allowances, annual maximums or limitations.  In fact, “80% of UCR” many times is not even calculated by the fees in the area but instead is some arbitrary number so the company can sell the plan to your employer at a specific cost per person.  Hence, it may not represent a practical fee for a given procedure.   It is more realistic to expect dental insurance to cover 35 - 65% of major services.  Remember the amount a plan pays is determined by how much the employer paid for the plan.  You get back only what your employer put in, less the profits of the insurance company.  Dental benefits differ greatly from general health insurance benefits.  In 1971, your dental-insurance benefits were approximately $1,000 per year.  Figuring a 6% rate of inflation per year, you should be receiving $4,549 per year in dental benefits.  Your premiums have increased, but your benefits have not.  Therefore, dental insurance is never a pay-all; it is only an aid or supplement.

 The cost of handling insurance within our office includes numerous lengthy phone calls, resubmitting information or radiographs (x-rays) two or three times because insurance companies "lost" or "never received" them, excessive paperwork, mailing and redundant billing.  Hence, the cost of handling insurance is not trivial and really is substantial.  Patience is involved since it takes at least 1 month for claims to be processed, it’s not unusual for 3 months and sometimes longer!

 Keep in mind that insurance companies typically reimburse the patient more quickly than the dentist.  Our financial policy is related to the above and our NOT filing insurance for patients in which we provide only endodontic examination and treatment planning is a direct result of the above.

Our Courtesy Service to

You for Insurance

1.     Researching your dental insurance plan and advise you of benefits available.

2.     Filing Insurance within 48 hours and usually requesting payment on your benefit to our office.

3.     Refilling insurance if needed.

Our Expectations of

You as the Policy Owner

1.      Payment of estimated out of pocket fees.  Promptly paying us for any remaing balance if needed.

2.     Understand the insurance policy belongs to YOU and we have NO leverage to obtain payment.

3.    Taking responsibility for payment if the insurance company does not pay our office within 90 days.

 

My insurance sent me a note saying they paid.

When do I get my refund?

 

Good Question!

It's not unusual for the insurance company to indicate they have paid us via a note sent to you.  Often though, the check is not really printed and mailed for up to 2 weeks after the notice is printed and sent.  Depending on the date insurance companies batch their checks which is typically twice per month, they might send the check or print it up to 2 weeks after the date of the note.  Once in awhile, it will take 30 days after the note from the insurance company before we actually receive the check. 

We also batch our refund checks sent to our patients.  It's more time efficient.  Typically your refund check will be in the mail within 30 days after we receive it under the worst case scenario.

 

Why doesn't my insurance cover the cost

of my dental treatment?

 

Dental insurance really is not insurance (as defined traditionally to cover the cost of a loss) at all.  It actually is a benefit, usually provided by an employer, that helps employees pay for routine dental treatment.  The employer buys the plan based on the amount of the benefit and how much the premium costs per month.  Most benefit plans are designed to cover a portion of the total cost of treatment, not all of it.

 

My plan says that my exams and other procedures

are covered 100% and you say it isn't.  What gives?

 

That's probably one of the best marketing hypes of dental insurance.  They claim to pay 100% or 80% or 50%.  The question is 100% of what?  The common misconception is that it's related to our fee.  That just is not true.  It's based what your insurance carrier allows and that is related to how much your employer pays the insurance company typically.

 

I received an Explanation of  Benefits from my insurance carrier that says my dental bill exceeded the "usual and customary".  Does this mean that my your charging to?

 

Many carriers refer to their allowed payments as UCR, which stands for "Usual, Customary, and Reasonable".  However, this does NOT mean exactly what it seems to mean.  UCR is actually a negotiated list between your employer and the insurance carrier for a given procedure.  The payment listing is related to cost of the premiums and the geographical area (typically by zip code of service rendered) where the work is done.  It almost all cases, the payment for the billed services is usually less, frequently much less, then what we charge.

 

More About our Office Our Financial Policy Endodontic Information for Patients Home Page

 

Joseph S. Dovgan, D.D.S., M.S., P.C.

Practice Limited to Endodontics
10585 N. Tatum Blvd., Suite D-132
Paradise Valley, Arizona 85253 USA
480-483-9001

"Where caring, skill, will and technology intersect while striving for endodontic excellence."

Serving Phoenix, Scottsdale & Paradise Valley, Arizona

Copyright 2000-2004 Joseph S. Dovgan, D.D.S., M.S. All rights reserved.

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