It is common for patients to use only a portion of the dental insurance benefits that are available to them. If not used, dental insurance benefits are often lost. Our knowledgeable staff is committed to helping patients accomplish their smile goals utilizing the full extent of their insurance benefits.
Dr. Patterson, through AAA Dental (in-network), works with more than 70 different insurance carriers. Check out our full list of partners. Dr. Jim Wright is an out-of-network provider. Our office will provide patients claim forms to submit to their dental insurance company. We do not file claims with HMO, DMO, or Medicaid.
Insurance coverage is essentially a contract between individuals and their insurance provider to cover at least a portion of the cost of necessary dental care designed to promote or restore health. Dental insurance does not cover 100 percent of the costs of dental care, nor do benefits extend to “elective” treatments such as holistic protocols and procedures, teeth whitening, veneers, or, in most cases, implants.
The extent of benefits is spelled out in each individual’s insurance policy. It is important to be familiar with the terms of your policy so that you may plan your dental care accordingly.
Following treatment, your insurance company will send you what is called an EOB, or “Explanation of Benefits.” This document explains the amount paid by the insurance company, as well as the amount that will be your responsibility to pay. While this may be the case, you are welcome to speak with our staff. We do make adjustments which benefit our patient, so your insurance company may not be correct about your co-payments or money due.
Networks are groups of dentists that contract with insurance companies and agree to accept a reduced, specified fee schedule for covered benefits. Dentists contracted by an insurance company are deemed “in-network”; those not contracted with the company are “out-of-network.” Some PPOs, or Preferred Provider Organizations, pay only for work performed by an “in-network” dentist. Others may cover the allowed portion as if performed by an “out-of-network” dentist, leaving the patient responsible for the balance. This is an important aspect of coverage to understand.
In Network – AAA Dental (Inside Four Seasons Dental)
Four Seasons Dental Spa has within it AAA Dental, a practice within our practice that is “in-network” for many contracted PPO plans. AAA Dental offers high quality care, and our AAA dentists do not place silver amalgam mercury fillings. Upgrades are also available to our patients who want the best possible outcome from treatment. An example is our white composite fillings – tooth-colored restorations considered both beautiful and healthy compared to downgraded silver amalgam (mercury) fillings. When the fees of the AAA Dental in-network provider exceed the allowances of benefits, we adjust the difference. For instance, if the cost of a crown, after the deductible has been paid, amounts to $1050, insurance coverage may be 50%, or $525. The remaining $525 balance would be paid out of pocket, which is in accordance with PPO dental benefits for in-network dental providers.
Out of Network
All of our incredible dentists at Four Seasons Dental Spa are considered “out-of-network.” Patients visit us for our outstanding commitment to patient care, and use of advanced technology and high quality dental materials. To accomplish results that last many years, Dr. Wright uses instruments that allow him to achieve the greatest amount of precision, leading to longevity of results. The use of microscopic surgical loupes, for instance, increases visibility of decay far beyond what the naked eye can see. This improved clarity also leads to the precise sealing of dental crowns, facilitating better function, less chance of leakage and future decay, and improved likelihood of tooth preservation. Many times, a leaking crown can lead to a root canal or extraction.
Our filling fees are inclusive of the upgrade to our BPA-free, white resin composite fillings and bonding material, the highest quality, and safest restorative materials for cavities. This type of filling, in lab tests, has been shown to strengthen teeth 7-8 times when replacing an old silver amalgam mercury filling. As a holistic dentist who follows mercury-free, mercury-safe practices, Dr. Wright follows the strict protocol of the International Academy of Oral Medicine and Toxicology (IAOMT) and the International Academy of Biological Dentistry and Medicine (IABDM) for the safe removal of mercury fillings. These protocols increase protective measures, decrease exposure to mercury particulates in the air, and there is an additional charge. For treatment that extends beyond the allowance of your insurance company, the difference is paid out of pocket. For example, if a crown cost $1200, and you have paid the deductible, and your insurance plan pays 50% of the allowance of $1050, or $525, your portion is 50% of $1050. The portion of the crown which insurance may pay is $525, and the difference between the Four Seasons upgrade and the allowance are both paid out of pocket.
Payments from insurance companies are not guaranteed. Our staff is happy to submit claims as a courtesy on behalf of our patients. We have no control over the review and payment processes of insurance companies. Dental treatment amounts not paid by insurance after the claim is submitted are 100 % the responsibility of the patient.
Most dental plans require participants to pay annual deductibles and copayments. If there is a deductible, this amount must be met before insurance benefits are paid. Copayments are per-visit payments made towards the portion of the bill not covered under determined benefits. Costs are explained in your EOB. Your insurance representative can answer questions regarding your deductible or copayment amounts.
It is common for insurance plans to deny coverage of excellent treatments such as white, BPA-free, mercury-free fillings, dental implants, VELscope oral cancer screening, bonding, laser gum treatment, laser surgery, orthodontics, holistic protections and protocols, and other beneficial services. In order to lower the cost of premiums, many patients, or their employers, choose higher deductible plans, or plans with limited benefits.
Many consumer products, such as clothing or cars, are manufactured on a scale, with some being the finest quality and others what you might call the “base model.” Dentistry, in terms of insurance benefits, is similar. Insurance companies may provide coverage of the least expensive materials and treatments available.
Most dental insurance companies downgrade to silver mercury amalgam fillings on the back teeth.
An example of the “downgrade” is amalgam (mercury) fillings. We choose to promote oral health through high quality care and materials such as safe, effective tooth-colored, BPA-free, composite fillings. We believe choosing a higher quality treatment than what insurance dictates, and paying more, leads to longer lasting results and better oral health. The investment into high quality today equals increased future value.
The Four Seasons Dental Spa Team wants you to have the option of receiving the highest standard of dental care. To enable more people to benefit from excellence in dentistry, we offer several different financial options. During your first visit at Four Seasons Dental Spa, you can learn more about our variety of options, and make plans to accomplish your oral health and smile goals on your terms. For more information on our financial and repayment options, you may also contact us NOW by calling (702) 309-4600. You may also speak with our practice manager, Debby, by calling (702) 281-9900.