|
Our Policy
Our policy is to prior approve all dental work through your dental insurance following your first visit, so that you always understand your copays. If you do not have dental insurance, we have flexible payment plans. Financing available, up to 12 months no interest, through CareCredit. We accept Mastercard, VISA, American Express and Discover for your convenience.
Financial
Plans With Participating Agreement
These are plans where we have a participating agreement in place. This means that they determine the maximum payment. They may pay 40%, 60%, 80% or 100% depending on treatment needed and your specific plan coverage.
Aetna (PPO)
BlueCross BlueShield of MA
Cigna Dental aka Connecticut General
Delta Dental of New York (all states accepted)
Dentemax
Empire BlueCross BlueShield (PPO)
First Ameritas
GE Financial Assurance/Signature Dental Plan
GEHA/Connection Dental Network
GHI Preferred Plus
Guardian/(PPO)
Horizon Healthcare
Horizon Dental PPO Plan
Metlife (PPO)
POMCO (PPO)
Principal Life
Rayant
United Concordia
United Healthcare (PPO)
White Plains Teachers Association
For all other plans, we accept payment from the insurance company but you will be responsible for the difference in fees.
In either instance, our goal is to let you know your out-of-pocket expense prior to commiting to major work. Candy is very knowledgeable and will help you with this.
Why Doesn't My Insurance Pay for This?*
UCR (Usual, Customary and Reasonable).
Under a UCR plan, patients are usually allowed to see the dentist of their choice. These plans pay an established percentage of the dentist's fee or pay the plan sponsor's "customary" or "reasonable" fee limit, whichever is less. Although these limits are called "customary," they may or may not reflect the fees that area dentists charge.
It may also be noted on your bill the fee that your dentist has charged you is higher than the reimbursement levels of UCR. This does not mean your dentist is overcharging you. For example, the insurance company may not have taken into account up-to-date, regional data in determining a reimbursement level.
Why? There is no regulation as to how insurance companies determine reimbursement levels, resuslting in wide fluctuation. In addition, insurance companies are not required to disclose how they determine these levels. The language used in this process may be inconsistent among carriers and difficult to understand.
Annual Maximums
Your plan purchaser makes the final decision on "maximum levels" of reimbursement through the contract with the insurance company.
Even though the cost of dental care has significantly increased over the years, the maximum levels of insurance reimbursements have remained the same since the late 1960's. Many plans offer higher maximums that are comparable to rising dental care costs.
Preferred Providers
Your plan may want you to choose your dental care from a list of their preferred providers. Whether or not you choose your dental care from this defined group can affect your levels of reimbursement.
Least Expensive Alternative Treatment
Your dental plan may only allow benefits for the least expensive treatment for a condition. For example, your dentist may recommend a crown, but your insurance may only offer reimbursement for a large filling. As with other choices in life — such as purchasing medical or automobile insurance, or buying a home — the least expensive alternative is not always the best option.
Preexisting Conditions
Just like your medical insurance, your dental plan may not cover conditions that existed before you enrolled in the plan. Even though your plan may not cover certain conditions, treatment may still be necessary.
Treatment Exclusions
Your dental plan may not cover certain procedures, or preventative treatments such as sealants that can save you money later. This does not mean these treatments are unnecessary. Your dentist can help you decide what type of treatment is best for you.
|
