Your office is not on the list of participating providers for my dental insurance company, can I still be a patient? Yes! Absolutley! Although we currently participate with only Delta Dental, Anthem Dental and Piedmont Community HealthCare Insurance Companies, we will file your insurance claims with all dental insurance companies and strive to receive the best compensation possible for the patient. The patient does not have to go to a participating provider for treatment , however, they may incur more out-of-pocket expense by doing so. It is best to contact your specific insurance provider and ask questions. The patient is the policy holder, pays the premiums in most cases, and should ultimately have their choice in choosing who provides their dental care.
My dental insurance does not provide enough coverage for the work I need to have done, it's too expensive. Why? Dental insurance benefits differ greatly from general health insurance benefits. In 1971, your dental insurance benefits were approximately $1000 per year. Some 35 years later, you will note that your benefits are still $1000 per year. Figuring a 6% rate of inflation per year, you should be receiving over $5000 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. In 1971, a crown may have only cost $60, today it's about $800! A small filling in 1971 was about $8, today it would be over $100. So, dental insurance companies have not kept pace with the rising costs of dental care, and more and more companies have dropped dental plans from their employee benefit packages.
My insurance company never pays the enitre amount of what the dentist charged. Are the dentists fees too high? How do I know? Why won't my plan pay more? You may receive notification from your insurance company stating that dental 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. Any doctor in a high quality private practice will have fees that insurance companies define as higher than "usual and customary". Call around different dental offices in your area and get a few estimates for certain procedures and research the fee averages in your area.
Is there anything I can do to make my dental plan better? Who do I talk with? Many plans tell their participants that they will be covered "up to 80% or up to 100%" but do not clearly specify plan schedule allowance, annual maximum or limitations. It is more realistic to expect dental insurance to cover 35% to 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. So, start by talking with the person in charge of managing dental insurance at your place of business. Show them examples of why it is not a good plan and ask them to renegotiate with other vendors with better coverage, or ask them to contact their state dental association and ask about Direct Reimbursement plans.
A friend of mine has been going to the same dentist for years, has never been told to change dentists, and her plan pays all of her dental expenses up to a certain yearly limit because the company she works for has a direct reimbursement plan. What is a direct reimbursement plan? Is your dental plan less than a perfect design for you and your employees? The answer may be Direct Reimbursement (DR) a self-funded dental plan offering an alternative to standard dental coverage purchased from insurance companies.
Direct Reimbursement allows you to design a dental plan that best fits your company and employees. Its a simple plan that is easy to understand. It is not insurance. It eliminates the insurance company overhead, thus saving money. Your dollars go for dental care, not costly administration.
With Direct Reimbursement, your employees visit the dentist of their choice, pay for their treatment, and submit the receipts. Benefits are paid DIRECTLY to them in a matter of days, not weeks. Contact our office or the Virginia Dental Association for more information on Direct Reimbursement.
What is the best way to schedule the initial visit with the office? Unless you are experiencing pain and have an urgent dental situation that requires immediate attention, the best way to schedule the first visit to the office is to set up a new patient examination. This is scheduled with the dental hygienist which will review the patient's medical history, gather background information, take necessary diagnostic records including x-rays, and assess the needs of the patient. Each patient is unique in their dental needs and our office provides a custom approach to achieving optimal dental health for our patients, not a "cookie-cutter" assembly line approach. In most cases, the prophylaxis will be completed on the same day as the initial visit, but in certain cases, it may be necessary to set up multiple future appointments to treat the patient and/or refer the patient to an appropriate specialist for evaluation.
How do I know if I need to see a specialist or not? Most dental conditions can be treated in our office without the need to refer to a specialist. There are multiple specialists in dentistry and each one focuses on a particular aspect of dentistry. Many specialists require or recommend a referral from a general dentist prior to treatment in their office anyway. It would be best to schedule a limited evaluation with a general dentist and let them decide on if referral to a specialist is necessary.
My dentist doesn't pull teeth or do root canals, do I have to go to a specialist? Not always. General dentists provide treatment that they are comfortable providing and can choose which procedures they are competent at as well as enjoy doing. Patients are always encouraged to seek second opinions if they are questionable.