Fees and Insurance
What You Should Know About Our Fees and Insurance
We strive to keep our fees as low as possible for the benefit of everyone. We do not establish our fees on the basis that insurance companies will pay them. As a benefit to you, we will accept insurance assignment on procedures other than initial consultation visits. Any balance remaining on your account after insurance payment has been received is your responsibility. We hope you find the following information useful. Insurance matters are often complicated, so if you have any questions regarding your coverage, please feel free to talk to Dr. Packman or our financial coordinator.
Our office establishes policies for payments of fees and acceptance of insurance reimbursement, but the more you know and understand about your insurance plan the better our relationship will be.
Please ask our staff about financial arrangements and payment options for extended treatment. For your convenience we accept Visa, Mastercard, Discover, checks and cash.
Initial Consultation and Maintenance Visits
In order to keep our fees as low as possible we do not accept insurance assignment for initial consultation visits. (We would have to raise our fees substantially to cover the administrative cost of doing this). We ask you to pay us for these appointments and we will be happy to file your insurance claim and have the insurance company reimburse you directly. We will accept insurance assignment on most other appointments.
Pre-Estimates and Explanation of Benefits
Before any treatment is rendered, Dr. Packman will provide you with a pre-treatment estimate which will include the costs for the procedure. This pre-estimate will be sent to your insurance company and they will let you know what your insurance policy covers. In todayâs market, dental insurance policies vary a great deal depending on what your company purchased. A problem common to most dental plans is that unlike medical insurance they have a very small yearly maximum allowance. Most dental plans have a yearly maximum of $1000.00 to $1,500.00 which unfortunately does not cover much in todayâs dollars. Dr. Packman started practice in 1973 and the average yearly maximum allowance at that time was $1,000.00. A thousand dollars bought something years ago but unfortunately dental insurance allowances have not kept up with inflation even though the premiums they ask you to pay have skyrocketed.
HMO'S and PPO'S
Some dental insurance plans are not insurance at all - they are medical PPO's or HMO's with a dental rider. These plans are usually a list of fixed fees for certain, (but not all) procedures, or a fixed percentage reduction in the fees charged. In these plans it is usually the patient who pays the whole treatment fee, but at the reduced rate. This is the worst kind of benefit, because it costs the patient the most out of pocket, but the insurance company pays little or none.
Usual, Customary, Or Reasonable (UCR)
Another way that the insurance companies limit their coverage is a term called UCR. Typically, the insurance company and your employer determine the reimbursement level that varies from 50% to 90% of what dentists in the area charge. For a particular procedure that most dentists charge $550.00, for example, if the employer wants to keep costs down, one option is to buy a plan that reimburses at a reduced level. In other words, instead of reimbursing at $550.00 or higher, it may only reimburse at $450.00 or less on the same procedure. (percentage of $450, instead of percentage of $550).
The insurance company calls $450.00 their "UCR Fee" so this reduces the cost of the insurance policy to your employer. If our charge is $550.00 (the amount that most dentists charges), the carrier is likely to state that our fee was above the "Usual, Customary, and Reasonable" fee. This comment would naturally make you think that our fee is higher than most, which is not the case. Although this can be a common misconception, it would be more accurate to state that your employer chose a plan that does not reimburse at the level most dentists charge in the area. The patient is responsible for more "out of pocket" expense because their coverage was reduced to lower the premiums of the policy.
It is also important to realize other employers with the same insurance company (or even those with a different carrier) would consider the $550.00 a "reasonable" fee. Our office strives to produce excellence on a daily basis. In many instances there is nothing "usual or customary" about how you are treated while under our care. Our fees are based on the skill, care, judgment and office environment that it takes to consistently provide you with the best care possible anywhere in the world.