Insurance

Will My Dental Insurance Cover My Dental Treatment?

Your insurance is actually a contract between the employer and the insurance company.  Your employer purchases a plan from the insurance company and chooses benefits based on the cost of the premium.  The majority of these plans only cover a portion of the fees for your dental care.  To know the actual cost your plan will cover, we recommend a predetermination be sent to the insurance carrier prior to treatment.

My plan states coverage 100% for preventive care, but that does not always hold true. Why is that?

The 100% stated in your policy is based on the negotiated fees between the employer and the insurance company.  This may or may not be the same fee Dr. Gordon charges.  For example, our office may charge $100 for a teeth cleaning and the guidelines set forth by your insurance company may allow $80 for the cleaning. This leaves a balance of $20 that is the patient responsibility.

Is it worth having dental insurance if I always have a balance due?

This is an individual decision.  Your insurance company is providing a benefit towards the covered procedures thus reducing the amount you will have to pay.

Why did the insurance company change the treatment to an “alternative benefit” which was less costly?

It is the insurance company’s responsibility to control cost associated with benefit coverage.  These benefits are negotiated with the employer and often will provide only for a less costly procedure. Obviously, Dr. Gordon has your best interest at heart and a responsibility to do the procedure he feels most appropriate to restore your tooth.  It is the responsibility of the dentist to provide the best treatment.  It is the responsibility of the insurance company to control costs associated with dental coverage.

Why isn’t my dentist in my network?

Dr. Gordon may not feel the treatment restrictions placed on them by “network” plans are in the best interest of his patients. He wants to be the one making decisions for his patient’s dental health.

What options do I have if my insurance does not cover my needed treatment?

The dental benefits for a patient have been negotiated between your employer and the insurance company. There can be some intervention on the part of the dentist but is limited.  Dr. Gordon can not make the carrier pay for treatment.  He can provide information to the insurance company stating the need for treatment but the final decision is up to the insurance company.  If there is a legitimate reason for the treatment, the patient can file a complaint with the state insurance board/commission.

Ours fees are determined upon knowledge, expertise and the delivery of quality uncompromised dental care.

As a convenience to you, we process all dental insurance claims in order for you to receive the maximum benefit. If you assign payment to our office, we request that you remit your estimated portion at the time of service.  Please remember you are fully responsible for all fees charged by our office regardless of your insurance coverage.

Our office participates with a number of insurance programs:

Guardian

Assurant Health

Aetna

Cigna

If you have any questions, please ask our office as our staff is well informed and up-to-date regarding these matters. We can be reached at Mark J. Gordon, DDS Phone Number (913) 649-4042 or email at [email protected].