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Dental Insurance Providers
Dr. Lewis T. Kulik - Our "In-Network" PPO Las Vegas Dentist
Dr. Kulik and Dental Insurance Providers are located inside Four Seasons Dental & Med Spa. Dr. Kulik specializes in serving our insurance patients, and you will feel very comfortable with him for all your dental needs. He is known for his ethics, dental expertise, gentle and concerned care, and his great sense of humor!
Dental Insurance. Your dental insurance plan is designed to help pay a portion of the costs associated with "medically necessary dental care", defined as treatment essential to"maintain or restore to normal health", not treatment that is considered "discretionary or elective treatment". It is important to note that insurance companies can only approve "payment"; only a licensed dentist can approve "treatment". The most common types of dental insurance plans are Preferred (or "Participating") Provider Organizations (PPO) and Dental Health Maintenance Organizations (DHMO). Dental insurance can be very confusing, and to make matters worse, every insurance plan handles things differently. Dental insurance plans are a contract between you and your insurance provider, in many cases, coordinated with your employer. Dental plans determine which services will be covered and which will not. They also set the payment method and the amount of payment. It is important that you read your insurance policy, or talk to your insurance representative, so you can understand how your plan helps pay for dental treatment.
PPO. A PPO is a network of dentists contracted to provide care at specific rates. Some PPO's pay only for dentists within their network, while others let you see your dentist outside their network. Depending on your particular PPO plan provisions, if you seek care from a dentist outside their network, you will either not receive any coverage at all, or you would simply exceed the allowance, and pay the difference for higher quality.
DHMO. We currently do not accept patients with DHMO insurance plans.
Payment. Most insurance companies have their own fee schedule, and they pay the percentage stated in your policy according to their fee schedule. They do not pay according to our fee schedule. We do our best to estimate what your plan might pay for recommended treatment, and while we are accurate most of the time, it is only an estimate. Most plans require deductibles and co-payments, and whatever portion of the bill not paid by insurance is your responsibility, as prescribed in their explanation of covered benefits and payment due for each claim filed, frequently referred to as the Explanation of Benefits (EOB). We file claims for you as a courtesy, but we have no control over your insurance contract or their payments.
Table of Allowances. This payment method lists the treatments the insurance plan pays for, and the fixed amount allowed for each treatment.
Usual, Customary and Reasonable Fees (UCR). This payment method sets a maximum fee amount allowed for treatment, then pays 50%-80% of that fee. You pay 20%-50% of that fee, plus the upgrade difference between that fee and the cost of treatment. For example, if a crown cost $1200, and your plan UCR fee is $910, and pays 50% of that UCR fee, the plan will pay $455 ($910 X 50%), and your portion would be $455 + $290 ($1200-$910) = $745.
Cost vs. Benefit. Dental insurance never pays 100% of care. Otherwise, you likely could not afford the extremely high cost of premiums without very high deductibles and co-payments, and very limited annual maximum benefits. Generally speaking, you get what you pay for: the greater the benefit, the higher the premium. If you want the insurance company to cover each and every dental treatment, you will pay a much larger premium than if you have lesser dental coverage. This is why many plans exclude newer technology, treatments and materials that they label as "discretionary or elective", rather than "medically necessary dental care". Because they are higher quality, they cost more than older technology, treatments and materials. Examples of frequent exclusions from dental plans are implants, porcelain veneers, white fillings, bonding, laser surgery, laser gum treatment, whitening, fluoride treatments and some periodontal care. In order to lower premiums, more and more employers and patients are choosing plans with higher deductibles and co-payments, more exclusions, and more limited annual maximum benefits.
Example of Decreasing Benefits. Dental insurance coverage maximums have not kept up with the times. In 1960, a typical annual maximum benefit was $1,000. Fifty years later, many plans still offer that same maximum, but to stay up with inflation, that $1,000 in 1960 would have had to increase to more than $6,500 today. What that means for you is that your insurance plan requires you to pay more and more out of pocket each year to keep insurance premiums affordable.
Quality vs. Value. In many cases, your insurance plan will cover only the least expensive dental procedures and materials, referred to by insurance companies as a "downgrade to an alternate benefit". An example of a typical "downgrade" is fillings. Instead of downgrading to mercury fillings, we offer only safe high quality white composite fillings. For all the foregoing reasons, it is quite common for patients to choose treatment that dental insurance does not pay for 100%. We urge you to "upgrade" whenever possible, and choose the highest quality treatments commonly found "out of network" and "in network" for an extra charge. The highest quality is the best value for your future dental health.
In Network: Excellent Quality - Great Value. Dr. Kulik and Dental Insurance Providers are located inside Four Seasons Dental & Med Spa. For patients who are limited to insurance benefits, Dental Insurance Providers is an “In Network” non-mercury practice, and provider for PPO plans listed here. For an extra charge, Dental Insurance Providers offers high quality white Nano composite fillings that are an upgrade from the typical dental insurance mercury downgrade!
Out of Network: Highest Quality - Best Value. Four Seasons Dental & Med Spa offers absolutely the finest quality materials and advanced technology available today. Only the highest quality porcelain veneers and crowns are used. Four Seasons Dental & Med Spa is an “Out of Network” non-mercury holistic practice, and for an extra charge, offers an upgrade to the safest and highest quality white Nano-hybrid resin composite fillings and bonding materials. In laboratory tests, these state-of-the-art fillings strengthened teeth 7-8 times!