Check Your Dental Insurance Policy
Most people with dental insurance today have either a PPO or HMO type of coverage. With both of these there are what is called a “network of providers.” HMOs REQUIRE you to go to a doctor in their network in order to get any coverage for anything beyond an emergency. Most PPOs on the other hand allow you to go to either an in-network dentist OR an out-of-network dentist. So whats the difference with a PPO between the in-network dentists and the out-of-network ones?
Just to give you my point of reference, we have not joined any networks, with the single exception of Delta Dental where we are a “premier” provider.
Here is the theoretical idea about networks. A dentist who joins the network has agreed to provide services to you at a fee that they have “negotiated” with the PPO insurance company. Many times this fee is less than the prevailing fees in the area so you might be getting a savings. Sounds good right? Well not so fast.
There are networks that we could join that indeed would require us to discount even further our already below area average fees. There are also networks where I would be charging significantly more than I do at present. The fees decided upon can be extremely arbitrary.
When a dentist is in a network he or she is also leaving themselves open to the insurer to come into their practice and audit the treatments that the dentist have provided. Why would they do this? So that they might see if the dentist is doing too many of one treatment or perhaps treating with a more expensive treatment something that could (not should) be done with a less expensive one. In other words: they are looking for any chance to save the insurance company money.
Remember, their goal is profits.
Our goal is the best care options for you at a reasonable and fair fee. Many dentists compensate for the network discounts by adding in all sorts of extra (what I call “nickel and dime”) fees. We charge straight up one fee for the treatment we provide. So many times WE are less expensive overall than the in-network dentists.
What’s more we stand behind our treatments to assure satisfaction and function.
If what you want is good solid treatment provided in an upbeat atmosphere at reasonable fees, then forget your network and bring your PPO to Pleasant Dental®. Call today for your appointment. (708) 576-1900.
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