Insurance 101 for Patients

Insurance 101 For Houston Dental Patients

Insurance 101 for Patients

Unfortunately, these days we live in a world ruled by insurance. Most dental plans have a yearly maximum somewhere between $1,000 and $2,500 per year and any dental work beyond that number will be an out-of-pocket expense for the patient. In addition, some plans have a deductible that will need to be met before benefits can be paid. This amount can be from $25 to $100.

DMO/HMO plans limit the patient’s choices on which dental providers they can see. Dental offices must contract and abide by the set fees for each procedure. We cannot accept or file for DMO/HMO plans.

PPO plans have both IN and OUT-OF-NETWORK benefits. You can see the dental provider of your choice, and they will pay the dentist a certain percentage of your dental procedures. You will need to pay your dentist the difference between the fee your insurance company established for each procedure and the fee your dentist charges. If your insurance has good benefits, there should be little difference for IN and Out-of-Network providers.

Let us look at an example: Your dentist fee for a particular procedure is $100. However, a PPO insurance company set their fee at $50. If your dentist is an OUT-OF-NETWORK provider, your insurance company will pay $50, but you will need to pay the additional $50.

In addition, if your dentist is OUT-OF-NETWORK, insurance companies do not share their actual fees with your dentist, they only share a percentage of coverage leaving dental offices to guess the actual dollar amount.

Quality of Care is what prevents most dentists from signing or contracting with insurance companies. They want to be able to spend the necessary time with their patients, use high quality materials and tools, continue education on modern dentistry, and make long-lasting and well-fitting dental restorations. This can only be achieved when they are compensated fairly.

Our office is OUT-OF-NETWORK with all insurance providers. However, we accept all dental insurances that ALLOW OUT-OF-NETWORK benefits. We take and file your insurance for you. As long as your insurance company does not bind you to a specific group of dentists, we are here to help all our patients collect and maximize their dental benefits. We do not bend our fees depending on insurance companies, rather set them fairly to provide the highest quality of care.

We hope this helps to clear up some potentially confusing aspects of dental insurance and as always, if you have any questions, please feel free to reach out to us here at Pure Prosthodontics.

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