Dental care can be costly. That's why you carry an insurance policy. Defiance Dental Group has the knowledge you are looking for when it comes to figuring out how to have your procedures covered, so you don't have to pay so much out of pocket.
Accepting PPO, HMO, and traditional insurance plans.
Enjoy electronic claims billing.
These programs are unique in the fact that you never pay any billing or annual maximum. The discount plans include a group of dentists who have agreed to a reduced rate for different procedures. Then you are responsible for the entire payment.
There are some procedures that are offered
at our office that may not be covered by your dental insurance policy. If you are requesting
a service or procedure that isn't on the fee schedule or goes above and beyond the minimum necessary, it won't be covered.
For most insurance policies, any procedure or treatment that is recommended by your dentist or any that is listed on the fee schedule will be at least partially covered. We provide detailed, electronic claims billing and are committed to maximizing your benefits. Please know however that treatment planning is based upon your dental health needs, not on what your insurance company will pay.
Indemnity or Traditional Insurance reimburses members or dentists at the dentist's UCR (Usual, Customary & Reasonable fee). This allows the subscriber to go to any dental office without being limited to a panel.
PPO (Preferred Provider Organization) is the most common form of insurance. They provide members with a list of participating dentists to choose from. The dentists on this list have agreed to a lower fee schedule, which provides you with greater cost savings. They also assist with insurance billing. Most companies pay 50% on major treatment (crowns, bridges, partials), 80% for basic care (fillings), and up to 100% for preventative care (exams, x-rays, basic cleanings). Annual maximums generally range from $1,000 to $2,000.
HMO, also known as capitated or prepaid insurance, was designed to provide members with basic care at the lowest rate. Participating providers receive a monthly capitation check for patients assigned to the office. This amount is only a few dollars and is intended to offset the administrative costs. HMOs generally don't pay for services rendered. Fees are usually greatly reduced, but the patient is solely responsible for paying the doctor.
Discount Plans simply consist of a panel of dentists that have agreed to a reduced rate, with the subscriber being solely responsible for the entire portion. There is no billing or annual maximums.
What's a covered benefit?
Treatment that is recommended by a dentist, is listed on the fee schedule, and accepted under the terms of your group's plan.
What's optional treatment?
Treatment that is either not listed on your fee schedule or more than the minimum to restore the tooth back to its original function.