This Web page answers some commonly asked questions about dental insurance.
"What insurance plans does your office accept?"
We accept all insurance plans that allow you to choose your own dentist.
"My insurance plan has a list of dentists that I have to choose from. Are you on their list?"
The only "list" I am on is with Delta Dental Insurance. I am a "Delta Premier Dentist".
Most "List" type of dental plans will allow you to go to the dentist of your choice. Many of our patients have PPO insurance and we bill their insurance for them so that they can get the maximum benefit from their insurance plan.
"Dr. Wilson, why haven't you joined all "List" type Dental Insurance Plans?
To answer this question, let me explain a bit about Dental Insurance. "List" Dental Insurance plans are called PPO's, DMO’s or HMO's.
PPO stands for Preferred Provider Organization. A PPO is a group of dentists contracted with a dental insurance company. These dentists have agreed to accept the insurance company's fee schedule (price list) instead of the dentists' normal fee schedule. Generally, the insurance company's fee schedule is about 30% below 'the usual and customary fees' of dentists in the area.
An HMO is a Health Maintenance Organization (sometimes also called a Dental Maintenance Organization or DMO). An HMO is a group of dentists contracted with a dental insurance company. These dentists have agreed to treat a particular group of people (usually a large company) for a fixed amount per month per person. With this type of plan, the payment reduction the dentist receives is greater than the PPO 30% reduction - the reduction if payments to the dentist is probably in the 50% range!
"How is it that other dentists are able to accept many of these plans?"
I cannot speak for other dentists, but I can tell you, from my perspective, what I would have to do IF I accepted many of these kinds of plans...especially HMO plans:
1. Compromise patient comfort during dental work: Sensitive mouths take extra time, extra numbing or using Nitrous Oxide ("laughing gas") takes extra time.
2. Compromise cosmetic quality of dental work: It takes extra time to get the shade right and make things look natural. Haste makes for an "assembly line" unnatural look.
3. Compromise overall quality of dental treatment: I would have to schedule less time for procedures and rush through my work. Poor quality dental work may not be noticeable at first but months or years later the problems start to happen.
4. use of less expensive dental lab for Crowns, bridges, and removable appliances are almost always made by the dental laboratory.
And the list could go on. The truth is Dentistry is a 'custom-made' service where the old sayings: "haste makes waste" and "you get what you pay for" are as true as ever! In my practice, patient Comfort and Quality Dental Work that lasts is priority! This is why I choose not to accept many of these plans.
I hope this helps.