Somethings in life are pretty easy to understand. Two plus two is four. Don’t yell “fire” in a crowded theater. Agree to all suggested bathroom breaks on a road trip. You get the idea. But when it comes to dental insurance, easy might not be the adjective most people use to describe it.
From figuring out co-pays and deductibles to calculating waiting periods and coverage percentages, learning to understand a dental plan can feel like a second job. At Just Wright Dental, our staff goes the extra mile for patients by not only verifying their plans and filing their claims, but also helping patients understand the process.
While every plan – even those covered by the same company – are different, one of the most common questions we hear has to do with in-network or out-of-network providers. There are some dental plans that will only pay out if patients go to a list of providers selected not by the patient, but by the insurance company itself. Most of these plans are HMO or DMO plans. If purchasing such a plan through your employer, the HMO or DMO plan may look to have the least expensive monthly deductible payments, but many patients find they must drive a long distance to get to a provider “on the list.” And many times if they do, the wait time for an appointment can be extremely lengthy.
PPO plans allow patients to go to any dentist they choose. However, with some plans there may be stipulations about in-network and out-of-network providers. If a doctor chooses to be an in-network provider, he or she basically contracts with the insurance company in question for payment at a set rate. The insurance company provides the dentist with the dollar amounts the company will pay for each procedure, regardless of the provider’s fee for those services. Sometimes, particularly when it comes to cleanings and preventative care, this may mean patients don’t have to pay anything out of pocket in the office. Other times, the patient may be required to pay the difference between the actual cost of the service charged by the dentist and what the insurance company pays. This is why it’s not uncommon for patients who, say for example, were covered by Insurance Company A through their work for years and never had to pay out of pocket for their annual cleanings to suddenly be given a $10 or $20 bill at each visit after their employer changed to Insurance Company B. The set rate Insurance Company A paid for cleanings was more than what Insurance Company B pays.
Some insurance plans pay a lower percentage of those fees to out-of-network providers. And while many people automatically think that means they’ll save more by going to an in-network provider, that doesn’t always prove to be true. If an in-network provider charges higher fees than an out-of-network provider, the patient may not be saving at all.
At Just Wright Dental, we pride ourselves on providing a high quality of service at an affordable price. We work with all PPO insurance plans and offer reasonable third-party financing options and payment plans. Additionally, we created the Wright Savings Plan for patients without insurance or for those who are underinsured or who just aren’t happy with their dental insurance options. This yearly plan gives patients access to all the x-rays, annual cleanings and exams they need for the year for one low price. Plus, it guarantees a discount on any dental work or additional treatment they need for the year.
If insurance issues have kept you from getting the dental care you need, don’t wait any longer. Call our office today and let us help!