At the time of your initial visit, your treatment plan will be established and an estimate of fees will be given to you. Our office will file your insurance paper work to help you receive all entitled reimbursements. Please bring your insurance forms with you and have your portion filled out and signed to expedite the filing of your claim.
Our insurance coordinator will be happy to discuss payment arrangements with you that will suit your needs. We accept cash, check, VISA, Mastercard, American Express, ATM and Discover for the payment for our services. In addition we offer extended payment policies, often without interest charges through a dental service financing company CareCredit™. Please ask our financial coordinator for details.
Our insurance coordinator deals with many different insurance companies. Some companies offer as many as six different dental and medical plans. Some companies combine dental and medical coverage. This insurance alphabet soup changes policies and guidelines weekly. At times, it is almost impossible to accurately estimate our patient’s insurance co-payment. Many insurance companies will not give out fees until after the treatment is completed. Dealing with these companies can be difficult and time consuming. As a courtesy, we ask that you keep us informed of any change to your insurance. It is important that all information about you and your insurance be current.
Our office will file your insurance claims for you. However, keep in mind that we may not participate as a “preferred provider” for your specific insurance policy, which may impact your reimbursement. If you have any problems or questions, please ask our staff. They are well informed and up-to-date.
A formal request to our Insurance Coordinator is required if you desire a PRE-AUTHORIZATION of your insurance benefits. Your dental insurance carrier will pay less than the actual fee for services. Therefore, all fees incurred are ultimately your responsibility regardless of insurance benefits.
What You Should Know About Managed Care Plans
What is managed care?
Managed care attempts to control costs by reducing utilization of services. Like traditional dental insurance programs, managed care plans limit the type and frequency of care. Unlike traditional plans, however, managed care programs will also limit benefits only to those doctors that agree to participate with their plan.
Dental health maintenance organizations (DHMOs), like medical HMOs, are a type of managed care system. So are Preferred Provider Organizations (PPOs), such as DELTA, and Exclusive Provider Organizations (EPOs). In these systems, dentists agree to provide care for certain patient groups at certain costs. In some plans, benefits may be paid according to the services provided. In others, such as dental HMos, dentists are paid a flat fee per patient per month regardless of the services provided. Ultimately, all these agreements compromise the quality of patient care.
Why isn’t Dr. Caplanis on my plan?
Our practice has tried to work with managed care plans in the past. Unfortunately, it has been our experience that plans interfere with the doctor patient relationship and promote low quality of care. Low quality dentistry ultimately leads to more tooth loss down the line, and in the long run more expense. It’s always less expensive to do it right the first time. Our practice motto is the “commitment to excellence”, which is our promise to you. Unfortunately, this commitment is not possible when participating with current managed care dental plans.
Our office is not for everyone. If you desire high quality dentistry at a fair fee, you’ve come to the right place. If you are looking for the cheapest Periodontist, or are trying to bargain hunt complex surgical services, then we are unfortunately not for you. Just keep in mind, that in Dentistry, as with many other things, you will get what you pay for.
Check your plan to see if there is a “freedom of choice” or “point-of-service” option. These enable you to seek care from any doctor of your choice. Under most plans, you will not receive full benefits if you select a doctor who is not associated with the plan. However, they still will cover some portion of the fee. If you are having difficulty financing the costs of periodontal treatment, please speak with our financial coordinator. We are here to assist you.
What does it mean if my plan says I cannot receive certain benefits?
All plans limit or exclude certain benefits, regardless of “medical necessity”. If your dentist or Periodontist has recommended treatment that is not covered, it is important to understand you still have options. One of these options is CareCredit™ which allows for extended payment plans.
Can I Refer Myself To a Periodontist?
Under managed care, your ability to see a dental specialist usually will be limited. Most managed care plans are based on a “gatekeeper” model, meaning each patient has one dentist who is responsible for providing all of their basic dental care and for managing referrals. Patients enrolled in these plans must be referred by their dentist in order to receive coverage for specialty treatments. In some insurance plans, there may be economic drawbacks for the general dentist to refer patients to specialists. These drawbacks exist, for example, if the general dentist is responsible for specialist fees. It is extremely important for you as a patient to be assured that your access to specialty care will not be restricted under any plan you are considering.
Will These Plans Have Any Impact On My Continuing Periodontal Care?
Yes. Managed care plans can impact the frequency of your periodontal maintenance visits. Under some plans, patients are allowed a certain number of recall appointments. Other plans may require periodontal patients to return to their general dentist immediately following advanced treatment, or upon plan enrollment. It is important that you continue to see both your Periodontist and general dentist following treatment. Periodontal disease is a chronic disease that must be monitored closely. Your Periodontist will work in cooperation with your general dentist to treat your periodontal disease and help coordinate your dental care.