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1765 E. Bayshore Road |
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| Phone: | (650)321-6911 | ||
Insurance Policies
Our office has one fee schedule that is very competitive for the area, approved by Delta Dental, and as affordable as most PPO plans.
We accept dental and union insurance plans as payment, including PPOs that allow you to choose your own dentist. However your estimated share of cost, if any, is expected at the time of service. As a courtesy, we will verify your coverage information, and handle the reimbursement paperwork. Ask about our discount plan.
We do not accept HMO, such as PMI, or Dentical plans. If your insurance limits your choice of providers, discuss changing insurance with your employer. The American Dental Association website offers alternative reimbursement ideas.
Understanding insurance and dental benefitsWe do not accept HMO, such as PMI, or Dentical plans. If your insurance limits your choice of providers, discuss changing insurance with your employer. The American Dental Association website offers alternative reimbursement ideas.
As you may be aware, insurance companies offer benefits which are becoming more confusing with less coverage, as employers demand cheaper policies.
Some types of insurance cover much of one's dental costs, while others only a fraction designed just to offset but not completely insure the dental needs of that individual.
Most policies fall with in three groups:
1.)HMO - during enrollment you must sign up and go to one provider on the list. Be careful with this plan. Although many items are covered well, large hidden expenses as well as lower quality may exist. Additionally, the provider can only be changed once a year.
2.)PPO - you may choose to go in or out of network. Insurance companies want you to go in-network as that saves them money. The network provider drops their fees in exchange for patients referred to them. One might ask why a good provider would need to make that deal. Out of network usually has higher quality using better materials and labs, plus you may choose your own dentist. Often you can negotiate with the out of network office to make your out of pocket costs similar to what it would be in- network.
Watch out for very low fee scheduled plans for individuals. Company negotiated in-network PPO fees are different from a cheap plan with a low set fee schedule. For example, out of network providers are often reimbursed by the PPO plan at a percentage of UCR (usual and customary rates) for the area; while a fee schedule is non UCR plan with very low fees that an individual and sometimes employers have purchased to reimburse the claimant for a particular service. No practitioner will accept that amount, in or out of network.
3.)Indemnity insurance where you may choose any private practice provider and the plan pays at UCR.
Other plans include direct reimbursement which is not insurance but an alternative program that many small businesses are using which provide excellent benefits while limiting costs. The employee has a certain amount of funds which he may use for his dental needs each year. The employer saves money by eliminating premium costs, and counting on the fact that many employees will not utilize their benefits completely.
With healthcare in flux, it is important to verify and understand your dental coverage. Your employer or provider may call on your behalf for a break down of your benefits and explain them to you. Sometimes the information given by the insurance representative is not complete or correct, therefore pre-authorizing extensive treatment may eliminate unpleasant surprises.
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