Dental PPO InsuranceDallas, TX
We will file for each patient any insurance benefits for which they are eligible, usually having the insurance company pay us directly (the exception is for Invisalign® orthodontics – see Invisalign® below). We will estimate the amount your insurance company will pay and collect any difference from you at the time services are performed, except where we have your insurance payment sent to you – in such a case the entire amount due must be paid in full for services to commence. We will credit insurance benefits paid toward the actual amount owed us for services, but you should understand that most insurance company contracts still require significant out-of-pocket payments by the patient, and any amount not paid by insurance is still your responsibility to pay completely before treatment is completed - even if we relayed to you something different after to talking to your insurance company earlier.
If you’re covered by an “indemnity” insurance plan, you may visit any dentist that accepts insurance (many dentists don’t by the way) and have your benefits, but you’re responsible to pay the dentist’s full fee regardless of the amount your insurance pays. We accept all indemnity plans. Indemnity plans have an annual deductible, annual maximum, co-pays on most non-preventive procedures, and a contractual amount they will pay after co-pays and deductibles for each procedure. This amount is dependent on what your employer pays for your premium to the insurance company and varies by company with the same insurance carrier. The amount is labeled “usual & customary charge” by the insurance company to make it sound like a standard rate, but it’s an arbitrary amount that is different for each company based upon the premium paid by your employer. Don’t be fooled by the insurance company or your HR department into thinking that it’s all you should pay; rather, it’s all your company is willing to pay toward your dental health. The use of the “usual & customary” instead of “your company’s contracted payment rate” is a true scam to mislead patients by insurance carriers.
PPO plans are similar to indemnity plans, except they offer a chance to save money through reduced fees by dentists who are “in-network”. In-network dentists participate solely to have patients referred to them by the PPO provider, and the PPO discount is a form of marketing expense they only have to pay when a patient pays them. A PPO member can usually also go to any dentist who is not in the PPO network but who will accept insurance, in which case the PPO plan operates like an indemnity plan. The difference is that the PPO plan usually pays the dentist a lower amount than an indemnity plan, so that the patient has a larger amount to pay that”s not reimbursed by insurance.
We accept all PPO dental insurance as an out of network provider, except for the ones where we've contracted to be in-network. Since these can change, we encourage you to call us and let us know which PPO plan coverage you have - we can then let you know whether or not we're in-network.
DMO plans are like “in-network”” PPO plans, but benefits can be paid only to dentists who are members of the network. Therefore, with a DMO plan, if you go to a non-network dentist you will get no insurance benefits at all. Interestingly, DMO plans pay participating dentists a fee if you don't go see them in a given month, which is often more than they pay the dentist if you do see them. In fact, DMO dentists lose money if you go to them for X-rays, cleaning, diagnosis, or fillings because they are not paid by the insurance company to provide those services. Given this crazy business model for DMO', our office is not a member of any DMO plan. Instead, we offer patients without insurance, and those stuck in DMO plans, our own discount plan.
Invisalign® orthodontics cost significantly more than conventional braces and are cosmetic in nature, so we are less likely to be reimbursed fully by insurance. Lab costs are a significant portion of the fee and must be paid by us up front, and since insurance companies tend to pay orthodontic benefits over the course of treatment, we will not accept assignment of any insurance benefits. Instead, we require payment in full prior to start of treatment. We will complete any insurance claims and file them for you as the payee so you can be paid any benefits directly by the insurance company.
Please contact us to answer any questions about your specific insurance coverage.
It is our goal to help you get the smile you want and the dental treatment that you need, regardless of the cost. Unfortunately, we are not a bank – but we have partnered with some excellent companies to provide you with options should you care to spread payment over time. Choices abound based upon the amount financed and the number of payments selected.
Our staff will be happy to assist you with the application process, which can be done quickly from our office.
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