Dental benefit plans are an integral part of health care planning for many families. These plans are made available to employees or members by companies, unions, and associations and may vary considerably from one plan to the next.
The range of benefits depends on what plan the purchaser wishes to offer employees or members. Some plans may cover as little as 30% or as much as 100% of dental services, with most in the 50% to 80% range. Some plans exclude certain types of services, while other plans will cover a full range of dental services.
Some plans base the reimbursement level you receive on a fee schedule arbitrarily developed by third party payers. For this reason, you may receive a lower percentage of the reimbursement level indicated in your dental plan. For example, if your plan states that it will pay 80% of the cost of dental treatment, it means 80% of the fee as determined by the insurance company, and not the actual fee that I, or any other dentist, charge.
I would like to clarify the principals of my practice, as well as the type of service and care I provide for my patients.
My fees are based on the costs of running my practice, the treatment plan selected, and my skills and expertise. I do not believe it is in your best interest for me to compromise recommended treatment to accommodate a dental plan’s maximum benefit which may be considerably less than optimal. However, I am happy to discuss a treatment plan’s advantages and disadvantages with you and involve you in the decision-making process.
The type of treatment you need and receive from me is based on my professional judgment; your dental benefits plan is merely an adjunct to help finance treatment that is in your best interest.
As a courtesy to you, my staff will submit your claims to your insurance company.
If your dental benefits plan requires a “pre-determination” or “pre-authorization”, I will submit a treatment plan for review by a third party payer. However, please remember that the financial obligation for dental treatment is between you and Belmar Smiles. The third party payer is responsible to you and not to this office.
If, after our discussion, you believe the dental benefits provided by your plan are inadequate, you may want to discuss the matter with your employer, union, or association so that appropriate alternatives can be explored.
Belmar Smiles will help you in every way in filing your claims. Please feel free to ask questions about your treatment, benefits plan, or statement. My office is here to help you. We can be reached at 303-935-3574 or firstname.lastname@example.org.