When choosing a dental healthcare provider, a lot of factors go into your decision-making: Where did the dentist gain his/her education? Does the dentist have a good reputation in the community? Is the office close by? And, last but not least, do they take my dental insurance?
We have been conditioned by insurance companies to believe that we can only see clinicians that participate with our insurance, otherwise known as “in-network providers”.
Our team is highly skilled in maximizing the benefits of every patient’s dental insurance plan as a way to help cover the costs of dental care. Your treatment costs will be discussed thoroughly before any treatment begins, and you are invited to share your questions and concerns with us at any time.
Can You Explain Your Fees For Treatments & Care?
Hey everybody, its Dr. Lepore back with another frequently asked question. We get asked in our practice a lot about our fees and so it thought I will take this little opportunity to tell you how we base our fees – and we really base it on three things. The skill it takes to do it right, the time it takes to do it well and the materials that we use to make it last. So let’s start with that first one – the skill it takes to do it right. When I came out of dental school I prided myself by wanting to be the best that I possibly could at what I did and so I started to take a lot of advanced education after graduation. Now just so you know it is an uncomfortable topic for me to talk about – how much I take especially for my wife God Bless her but we are required to take 32 hours of CE every two years as dentists. In our office we take close to 200 or 250 in some years. so we do that so that we could provide the best care and the most modern and current care. Secondly if you are going to do something well it takes time to do it – so when I started my career I worked for one of the corporate chain practices and I would see anywhere between 25 and 30 patients a day and that doesn’t even include the time I would go and do exams for patients in hygiene. In our practice now I may see 8 – 10 people at most and let me tell you why – in order for me to do the best work, I have to be attentive, present and I have to be able to not be interrupted when I am doing the best care that I possibly can and I found that if I spaced myself accordingly I was able to provide just that. Some models are much more volume driven – you will see 8 to 10 people sitting in the waiting room. We see 8 to 10 patients maybe all day. Lastly I want to talk about the materials we use to make things last, there are so many different types of crowns and filling materials and different cements that we can possibly use an I can tell you that the good isn’t cheap and cheap isn’t good – so we take that mantra not just to our practice but to the materials that we use. So rather than send your work to an overseas laboratory where we might pay a third of what we might pay here – we use a very high quality lab right here in the US and the same goes for the other materials we use – we use the top materials that are backed by research that are going to give longevity. We certainly won’t be the cheapest dentistry that you’ll find and we actually take pride in that for the same reason that you probably take a lot of pride in your work, we certainly take a lot of pride in ours.
But is it Dental “Insurance” or Dental “Assistance”?
It’s not news that employers have reacted to the rising costs of healthcare benefits by shopping carefully for the policies that they offer their employees. Benefits are down while restrictions and exclusions are up. Our patients share their resulting frustration with us every day. Adding to the frustration is the fact that dental benefits are often represented as being comparable to other types of insurance. “Insurance”, by definition, is protection against unpredictable or catastrophic loss.
But most dental benefit plans specifically exclude extraordinary needs.
The things offered as benefits are not only predictable, but expected, such as routine exams, x-rays, healthy cleanings, etc. Further, policies that do offer a benefit for other common services, such as crowns and treatment for gum disease, provide them at a much lower percentage of the actual cost of providing that care, and with a low dollar limit per year. Your dental benefit plan can be an excellent maintenance assistance program that will help you protect your investment in your dental health, and we’re happy you have that assistance!
Another common misrepresentation is that dental “insurance” covers all of the things that you need.
We believe this can be a danger to your health, because it implies that if it isn’t covered, you don’t need it.
Insurance companies are in business to make money. This is no secret and it’s not bad or wrong. Their responsibility to their shareholders is to provide the benefits they can while still creating profit within the investment you or your employer has chosen to make in dental health. You cannot count on a dental benefit plan to determine what you need. It’s our responsibility to advise you regarding your health. The fact is, even those with excellent dental health still need to make an investment.
We invest in what we value. Home improvement, education, vacations, are all examples of things we pay for, by choice, because we value them. We don’t presume to know where dental health fits in your value system. That’s for you to decide. It’s important for us that you know we think you’re worth the investment, and we’ll work with your benefit plan to see that you receive the maximum benefits in assisting you with the maintenance of your health.
We work with and welcome ANY questions about your dental benefit plan
While we are not contracted with any dental insurance carriers, we file all claims for patients as a professional courtesy. We are known as what is called a fee-for-service office.
What is Fee-For-Service Dentistry?
When you hear the words “fee-for-service dentistry,” it may sound like a deterrent. Does it mean cash only? Does it mean no insurance is accepted? Will it be grossly more expensive?
Here’s what the reasoning behind fee-for-service really is, and how it can benefit the care you receive.
Quality Over Quantity
Many dental patients feel restricted by their dental insurance. They find an increasing number of exclusions, limitations (including frequency of services), downgrades, and waiting periods. They may also suffer in that they’re not able to select a provider that offers the level of quality care they are looking for. However, many fee-for-service dentists do accept insurance, even if they do not participate as a “preferred provider” in the plan that you carry.
Working outside of the confines of insurance allows the fee-for-service dentist to charge a fair and fixed fee for the specific procedures that they offer, rather than have their fees managed and dictated by a third-party insurance provider. Most often, insurance “reimbursement” is far less than the value of the procedure, clinician’s time, and materials used. Because of this, participating (in-network) providers tend to see many more patients in the same amount of time as compared to non-participating (out-of-network) providers, to make up for the difference between the actual value of the procedure and what the insurance company will pay. Many of these reimbursements are so low that the quality of materials, results, amenities and your experience is compromised.
“Going Fee-For-Service allows our office to provide ONE standard of care… the standard we would provide for ourselves and loved ones.”– Dr. Ryan Lepore, DMD
By going fee-for-service, it allows our office to use only the highest quality laboratories to fabricate your dental restorations and utilize the materials with the best long-term success and aesthetics rather than having to select lower-quality facilities/materials in order to meet cost restrictions. As a result, patients will be able to receive excellent care that isn’t restricted by an insurance carrier.
More Personal Relationships
In a fee-for-service office, you can expect much more personalized care with the proper attention given to each patient and their individual needs. When you become a patient at Lepore Comprehensive Dentistry, you become a part of our family and can expect to be treated as such each time you visit. This not only means friendly, familiar faces are always present but also includes your dental team remembering the personal touches that make your visit a pleasant one, like providing your preferences from our comfort menu at every visit.
“Having the proper time with patients increases the quality of the relationships that can be formed and the dental work provided”– Dr. Erin Dougherty, DMD
In fact, where many volume-driven practices have 8-10 patients in the waiting room to see the doctor, our doctors may only see 8-10 patients in their doctor chairs each day. This allows the proper time for a true doctor-patient relationship to be developed. Patients can expect a far more customized experience and most importantly, feel truly heard.
Payment At The Time Of Service
At our office, we request payment in the following way: having the patient pay for their services at the time of treatment. The patient will then be reimbursed directly from the insurance company for the respective services provided. We have extremely flexible payment options, including in-house and 3rd party financing <click here for more details> to help offset any cost incurred for the recommended treatment.
Will You Pay Significantly More?
In a fee-for-service office, typically, there will be an increased cost compared to an “in-network” provider, however, the discrepancy is nothing compared to what you will see in the medical industry for out-of-network vs. in-network out-of-pocket expenses. It simply means that if there is a difference between our fee and the allowable fee set by your insurance, you are responsible for the difference.
So, does this mean that you will pay more for an out-of-network provider?
You might. However, it is usually not a large amount, contrary to insurance company rhetoric, and it is worth the price for the increase in time and the quality of care provided.
Our fees are based on “Usual and Customary Rates” for our area (based on zip code) and are usually still within or very close to the allowable fees set by a lot of insurance companies. Most patients experience a minimal to modest increase in the out-of-pocket for preventive care and a moderate increase on major treatments. Many patients fear that they will pay upwards of 10-20x out-of-pocket compared to an in-network provider and this is simply not the case.
What Happens Once Insurance Is Filed?
Our office is happy to file insurance claims on their patients’ behalf as a professional courtesy. We will continue to appeal and fight on your behalf for proper benefit reimbursement.
Even though you are paying our office directly, we manage all of the paperwork, forms and documentation that is needed to seek reimbursement for your plan’s coverage. You will not incur this responsibility.
It’s important to note that insurance claims can take well over 30 days or more to file, process, and have a reimbursement check sent out. Once processed, the payment should be made and mailed directly to your home address. If you don’t receive a check within 30-45 days or the reimbursement appears to be under the anticipated amount, we ask you to save your EOBs (explanation of benefits) and we will help appeal any claim on your behalf.
An Advantage for Patients & Dentists
Fee-for-service dentistry is a deterrent for some patients when seeking out a new dentist; but the truth is that when you want to seek the best care at a competitive fee, going to a fee-for-service dentist provides both you and your dental practice with more freedom in regard to what’s possible for your smile. Fair pricing allows our office to select ideal procedures and methodologies, rather than the ones that will “only fit into the insurance plan’s package.”
We invite you to call our office at (727) 608-4690 to talk with us about your plan.