QUALITY OF THE PURCHASED INSURANCE:
Many of our valued patients have the privilege of having dental insurance. Your dental plan is a form of compensation your employer provides, a coupon to be put toward offsetting the fees for the care you need. You may expect the carrier (insurance company) to reimburse you for a portion of our fee. That portion is determined by the contract between your employer and the insurance company. The higher the premium paid by your company, the more generous the reimbursement. Your dental insurance policy is an agreement between you and your insurance company. We are only a third party to this contract.
QUALITY SERVICE vs. “COST EFFECTIVE ALTERNATIVE” BENEFITS:
Please remember that our philosophy of dental care is to provide the best oral health possible for our patients regardless of insurance policy limitations. To do otherwise would violate our pledge to you – the only contract we feel morally and ethically privileged to honor. Therefore, as caring professionals, we will recommend treatment based on our extensive training in the field of Dentistry. Many insurance companies “determine that an alternative method of treatment is as appropriate and cost-effective” as the treatment planned by us. Eventually, in many instances, the “cost-effective” option leads to more extensive treatment. Therefore, we diagnose and recommend the BEST customized treatment options based on each individual’s needs.
OUR OFFICE: With most insurance plans we do accept ASSIGNMENT of BENEFIT
(where you authorize your insurance company to reimburse our office directly) unless otherwise restricted by your individual plan (some Delta plans or HMO’s) For instance, after you authorize ASSIGNMENT of BENEFITS, Plan A may reimburse our office directly, whereas, Plan B may reimburse you directly regardless of your authorization (i.e. some Delta PPO plans).
Please be aware of these variations and familiarize yourself with your particular plan. As a courtesy, our office will assist you in preparing and submitting the necessary forms for these benefits. We make every effort to work with you to receive the CARE that you deserve and also with your insurance company so you would receive the maximum reimbursement to which you are entitled.
INSURANCE COMPANIES: Ultimately the insurance companies determine the
reimbursement when they receive a claim. Please remember NO company attempts to cover all dental costs. Here are some variations on methods of calculation for benefit reimbursement used by these companies:
1. Fixed allowances for a specific procedure(i.e. a flat $75 for an exam)
2. Arbitrary UCR (Usual-Customary-Reasonable) formula based on internal plan controls and carried out at the sole discretion of that plan. (this is a tricky one because this can change annually or even monthly usually for the insurance companies’ profit margin!)
3. Straight Percentage of the submitted fee for services.(i.e. 80% of submitted fee)
4. Downgrade to a more ”cost effective” fee for their company. In other words, any variation of 1,2 or 3 but applied to a lesser yet “cost Effective” treatment reviewed by a claim adjuster(usually not even a licensed dentist!) (i.e. only covering 80% of the procedure DOWNGRADED to a “Cost effective Alternative”, leaving you to pay the 20% copay and the difference between the alternative fee and true fee submitted)
5. Denial any payment based on limitations in each individual plan( i.e. timelimits” WAITING PERIOD”/pre-existing condition/replacement clause/”not a covered expense” etc.)
YOU: It is your responsibility to pay the deductible amounts, estimated portions, and balances not covered by your insurance company. (For an ideal example: if the fees for your appointment were $100.00 and your insurance will only estimate to cover 80% of that procedure, you would be required to pay $20.00 for that visit). If the reimbursement payment is not received from your insurance carrier within 45 days from the date of service, as a courtesy we will inform you of this delay first and have you get in touch with your company to reimburse you directly; however, we require that you pay the remaining balance immediately.
At Naperville Family Dental Care (NFDC ) Dr. Adel and our team are ready to assist you on your journey to a beautiful, confident smile. We have been proudly serving our amazing patients in Naperville, Aurora, Lisle, Warrenville and surrounding western suburbs of Chicago, in Illinois since the year 2000.