FAQ: PATIENTS+

• Our goal is to provide quality individualized dental care. Late cancellations, no show, late arrival inconvenience those individuals who need access to dental care in a timely manner. If you are unable to make your appointment, we kindly ask please inform us at least 48 hours in advance (2 business days); it will enable us to better utilize available appointments for our patients in need of dental care.

• “Late Cancellation” shall mean any patient who cancels an appointment less than 48 hours before their scheduled appointment.

• “No Show” shall mean any patient who fails to arrive for a scheduled appointment or patient who arrives at our office 15 minutes after their scheduled appointment and unable to be seen. 

• $75 Fee for Late Cancellation / No Show Policy.

Our Promise of Privacy and Consent to Patient Records (HIPPA)

Our office is fully committed to compliance with the HIPPA guidelines by:

• Providing appropriate security for our patient records.
• Protecting the privacy of our patient’s information.
• Providing our patients with proper access to their records.
• Appropriately maintaining our patient information and billing processes in compliance with national HIPPA standards.

If you ever have any questions or concerns about your services or charges, we encourage you to please call so we can clarify your concerns.

We have increased our procedures to help keep you safe.

In addition to following the proper CDC guidelines throughout the office and continue to uphold hand washing/hand sanitizer guidelines. We use an EPA approved, hospital-grade disinfectant throughout our office. Exam and treatment rooms continue to be cleaned with extra attention.

• The office has installed an air purifying device called iWave Air. iWave is an air purifying device that installs in any duct air conditioning system. When air passes over the iWave, ions produced by the device reduce pathogens, allergens, particles, smoke and odors in the air, creating a healthy environment without producing any harmful byproducts.
• The office has also installed an air disinfecting purifier called ADP-70. The ADP 70 air disinfection utilizes a proven technology commonly used in hospital HVAC systems called Photocatalytic Oxidation (PCO). These charged ions, referred to as Hydroxyl Radicals (HO), are powerful oxidizers that destroy particles as small as .001 microns. HEPA systems only filter particles down to 300 microns. The ADP 70 continuously emits HO for on contact removal of contaminants.
• The office also uses a Pureclean electrostatic air fogger. It uses the power of electrostatic technology that creates finer particles than the regular foggers, allowing the solution to stick to surfaces. The solution we use is Hypochlorous Acid, a naturally occurring cleaning solution.

As part of our dental family, we value our commitment to deliver quality lifetime dentistry. During your dental visit, it is also our goal to maximize patient safety.

Dental insurance is one of the most beneficial and most misunderstood factors in dental treatment today. This explanation will attempt to clear up many common misconceptions about dental insurance.

Dental insurance is a contract between the insurance and the patient that helps cover the cost of treatments to your teeth and gums. It has NO CONNECTION at all to the provider of dental treatment (the dentist). It has absolutely nothing to do with the level of service provided by the dentist and the fee charged for these services. The extent of coverage varies greatly from company to company. Not all dental insurance plans are the same, so it’s important to understand the basics. 

Instead of you paying 100% of the cost out-of-pocket, dental insurance pays a percentage and you pay the rest. Many people get dental insurance through their employer, but you can buy an individual or family dental insurance policy directly from dental insurance companies.

How does dental insurance work?

Like health insurance, dental insurance works by sharing the costs of dental care in exchange for a premium you pay. You may also have to pay deductibles, copays and other costs, but the details vary from plan to plan. Here are some common terms of dental insurance plans:

Premiums

A premium is what you pay your insurer in exchange for coverage. Premiums are typically billed monthly, but some policies may collect them semiannually or annually. A typical premium may be $20–$50/month for an individual or $50–$150/month for a family based on the type of coverage.1

Deductible

A deductible is the amount you pay toward certain dental expenses before your insurance kicks in. For example: if you have a $1,000 deductible, you pay the first $1,000 of covered services and then a fixed amount (ex. $20) for covered services after the deductible is met. Deductibles typically reset after 12 months.

Coinsurance

Coinsurance is a payment you may be responsible for after you meet your deductible. For example: if your dental plan pays 70% of the cost, your coinsurance payment is the remaining 30% of the cost.

Annual coverage maximum

An annual maximum is the limit your dental insurance will pay toward the cost of dental treatment in a plan year. For example: if your annual maximum is $2,000 and your plan has already paid $2,000 in the first 6 months, you’re responsible for 100% of the costs for the remaining 6 months.

In-network vs out-of-network

A network is a group of dentists who have agreed to provide care based on a plan’s terms and conditions. If you choose an in-network dentist, you’ll typically pay less for treatment. If you choose an out-of-network dentists, you could pay higher deductibles, copays and coinsurance.

Reimbursement

An insurance reimbursement is the money your insurer pays to a dentist to cover the expenses of the services provided. Typically, the payment occurs after you receive a medical service, which is why it is called reimbursement.

What does dental insurance cover?

There are 3 common categories of dental insurance: preventive, basic and major. Many plans take the 100-80-50 approach to coverage, which means preventive care is covered at 100%, basic care is covered at 80% and major care is covered at 50%. Here’s a closer look what dental insurance covers:

Preventive care

Preventive care aims to “prevent” wear and tear, gum disease and tooth loss. Routine visits allow your dentist to examine your mouth, jaw and neck to identify problems and treat them early. Common services covered under preventive care include bi-annual cleanings, oral screenings and routine X-rays.

Basic care

Basic care treats minor-to-medium damage that has already happened, like toothaches and gum issues. Common services covered under basic care include fillings, tooth extractions, root canals and gum disease treatment.

Major care

Complex dental work, including surgical procedures, are typically classified as major dental care. These services can range from crowns and implants to dentures and oral surgery.

What does dental insurance not cover?

Most dental insurance plans don’t cover cosmetic procedures (teeth whitening and veeners) or orthodontic treatments (dental braces). Some policies also don’t cover pre-existing conditions like missing teeth that were lost or damaged before receiving insurance.2

How much does dental insurance cost?

Similar to what each plan covers, the cost for dental insurance will be different for each policy. Factors that can affect how much you pay for dental insurance include:3

• Where you live
• Your age
• Copay
• Coinsurance
• Annual maximum benefit

Can I buy dental insurance without health insurance?

Yes, you can buy dental insurance without health insurance. When you purchase a health insurance plan, it doesn’t automatically include dental coverage. Dental insurance is separate from health insurance.

You can buy dental insurance anytime of the year and from any insurance provider. Before deciding, be sure to research your options to find the best coverage for you and your family.

What’s the difference between an HMO plan and PPO plan?

A health maintenance organization (HMO) plan and a preferred provider organization (PPO) plan work the same for dental insurance as they do for health insurance. Here’s a quick definition of each:

Dental HMO plans

Dental HMO plans typically cost less than other dental insurance plans, with lower monthly premiums and less out-of-pocket costs. With these types of plans, you’ll only get coverage when you visit dentists and other specialists who are in the HMO network.

Dental PPO plans

Dental PPO plans tend to cost more than HMO plans, with higher monthly premiums and out-of-pocket costs. The higher cost is in exchange for the flexibility to use dentists and providers both in and out of network.

There are four main categories of dental insurance:

• Indemnity
• P.P.O. (preferred provider organization)
• H.M.O. (health maintenance organization)
• Direct Reimbursement (self -insured)

Both a Direct Reimbursement program and an Indemnity plan allow you to see the dentist of your choice without any restrictions. A Preferred Provider Organization otherwise known as a P.P.O. is a financial agreement between the insurance company and the dentist, whereby the dentist agrees to lower his fees to meet a prescribed fee schedule administered by the dental insurance company and sold to your employer for a reduced insurance premium. You are given a list of providers who honor the P.P.O. program. Most patients assume that you must see a provider on the list only and this is NOT true. What insurance companies fail to convey, is that you can still visit the dentist of your choice BUT it will cost you more as a non P.P.O. dentist has not signed your insurance companies reduced fee contract.

Also known as Capitation plans, H.M.O’s are generally programs, by which you, as a patient pay little or nothing out of pocket for your dental needs. Your dentist, chosen off a list, is reimbursed monthly at a small flat rate per patient. This money is received even if the patient does not come in or has no treatment done. You must leave the dentist with whom you have established a relationship and choose a new dentist from a list supplied by your employer. Unlike a P.P.O. plan, you can only visit dentists who have contracted with the H.M.O.

These programs are based on a principle where the dentist is placed in a financially advantageous position if he or she performs little or compromised treatment on a patient. Furthermore, the dentist benefits to an even greater degree if the patient never comes in at all. Here are some paraphrased excerpts from a Dental Association newsletter sharing the Association President’s views on these plans:

“I finally concluded… it is extraordinarily difficult to maintain quality, honesty, and consistency and still make a living with these programs. In order to break even with these programs, you must: discourage treatment of early cavities, downgrade the classification of periodontal disease, extend amalgam fillings to more surfaces than the cavity calls for, not schedule recall visits, allow appointments only during the least desirable times, and basically do as little as possible. What good will I be if I skimp on quality, intentionally under-diagnose, and operate dishonestly?”

NiceDentist.com encourage regular preventative visits and optimum treatment. We feel that we take the necessary time that each patient requires to get them to the best state of oral health while maintaining a friendly, relaxed, and most of all, personal atmosphere. We truly care for every single patient, and your continued feedback, compliments, and referral of friends and family always make us proud. We strive to provide you with top quality comprehensive care at a reasonable fee. It is unfortunate that many of these cost cutting insurance plans cannot allow us to do so.

It has widely been accepted that insurance benefited the dental profession by allowing patients to receive treatment that they might not be able to afford on their own. With the cost of coverage escalating, many dentists question whether insurance is still the asset that it once was. Some have even begun to wonder if insurance should be involved in dentistry at all. The Insurance Companies have responded by promoting Preferred Provider Plans (PPO`s) and HMO`s which eliminates your employees freedom to pick their own health care professional and drastically reduce payments to providers resulting in long waits for dental appointments and less than satisfactory dental care.

Insurance, by definition, protects against a potentially catastrophic loss that is impossible to predict. That’s why you need life insurance, medical insurance and long term disability insurance. But dental treatment is highly predictable and non- catastrophic. It’s prevention orientated. It involves frequent claims of relatively small dollar amounts. Most dental plans sold by insurance companies, have an annual maximum benefit of $1000 or $1,500. It is clear that they are not designed to protect against catastrophic expenses, but to assist you with routine expenses. Since dental benefits aren’t really insurance, it’s not necessary to involve insurance companies in the dental benefits loop. You don’t need to insure a routine expense that is predictable and budgetable. Insuring yourself for dental expenses is like insuring against haircuts or utility bills!.

According to the American Dental Association only 50-60% of people who have dental benefits ever visit the dentist in a given year. Less than 5% who have dental plans with a $1000 annual maximum benefit actually reach the maximum benefit each year. The average dental expenditure per person in the United States is less than $160 a year. Less than 5% of the total health care dollar is spent on dental treatment. Many don`t realize that 50% of the dentistry performed in this county is still paid for out of pocket by the patient. Yet, in spite of these figures, many employers still believe that they need the security of an insurance company in order to provide a dental benefit for their employees.

What many fail to realize is that an insurance company costs (overhead and profits) can consume up to one third of the premiums an employer pays for a traditional dental plan. By being self insured or self funding you eliminate the insurance company and many of the expenses associated with it, resulting in a savings of 19 -29 percent compared to many fully insured plans.

A self funding company has two ways to administer dental benefits. Implement a company traditional dental insurance plan which would need to be handled by a third party administrator with administrative costs between 7% to 14%, or a direct reimbursement (D.R) plan which would reimburse the employee a percentage of the dental services rendered. D.R. which is strongly supported by the American Dental Association shows administration costs of 3.5% to 7.5%, about one-half of the administration cost of a traditional self-funded plan.

Direct Reimbursement (D.R.) is a simple method an employee can use to provide dental benefits for their employees without an insurance company involvement. The employer selects or customizes a reimbursement plan that suits their budget or needs. Benefits are typically stated in dollars as a percentage of the expenses incurred, up to the limit of an annual maximum which is determined by the employer. Employees visit the dentist of their choice and pay for the treatment they receive. They then present a paid receipt to their employer who reimburse them for all or part of the expense incurred. Below is an example of a D.R. plan

Dental Expenses Employer Pays Employer Pays Eligible Benefit

First $100 100% 0% $100

Next $500 80% 20% $400

Next $1000 50% 50% $500

Annual Maximum Allowance per person: $1000

This method ensures that the plan pays only for actual dental services received, that employees go to the dentist of their choice, and that virtually all of the monies spent go for dental treatment. The variation of the different plans is limited only by the degree of financial commitment the employer is prepared to make. An employer may begin its plan by offering a conservative annual maximum, and then revise the benefits level at any time.

As dentists we are constantly sandwiched between the Patient and the Insurance Companies. In many situations treatment rendered is tailored around what benefits are covered, which may not be in the patients best interest. Patients should be able to receive treatment that best meets their needs without third party intervention. Direct Reimbursement emphasizes direct employee to employer, patient to dentist relationship. Employers realize savings by eliminating costs due to complicated claims adjudication, service restrictions and exclusions, participating provider lists and insurance company profits. Besides the cost savings, the D.R. concept usually means an increase in benefits to the employees. Traditional plan designs contain deductibles, waiting periods, UCR limitations and excluded procedures that dramatically reduce the benefits available to employees. D.R. plans eliminate most of the limitations that reduce benefits. Most traditional plans reimburse on average 54% of the patients actual expense, while employees covered by D.R. plans are covered between 64% to 77% of their actual expense. The higher benefit levels are affordable to the employer as a result of the reduced administrative fees and the employee’s prudent use of dental services.