Today, I received in the mail a shiny booklet with a list of doctors who are preferred providers for our health insurance. Already, itʼs the second version Iʼve gotten this year. It was no surprise that none of our family physicians made the list. Oh, well.
But, you ask, now you have to change all of your doctors and have all of your records transferred to find someone on your list. You even have to find a new pharmacy because your insurance company wants you to get your prescriptions online. What a pain.
Fortunately, this is rarely true. Despite what my insurance company would like me to believe, I still have the right and the freedom to pick a doctor with whom Iʼm most comfortable. A preferred provider list is simply one that your health insurance company would “prefer” you to go to, not an absolute mandate. Most every time, there is fine print somewhere that will allow you to see an “out of network” doctor. In our case, all of our friends (who also happen to be our family physicians) are out of network. We stay with them because the small difference in coverage does not make up for the relationships and trust they have built up over the years. Plus, we are just hard headed enough to want to make our own health decisions.
One of the most common calls to our dental office has to do with the initial question, “Do you take my insurance?” In most every case, the answer is an absolute, “Yes!”
There are only three types of dental plans where you are forced to see a dentist on a list. Type one is Medicaid or CHIPs dental coverage. These are government programs where a dentist has to sign a contract with Uncle Sam to get reimbursement. To use your benefits, you have to go to a provider. Dental Maintenance Organizations (DMOs) are insurance plans where you have to see doctor from the insurance companies list. Similar to medical HMO plans, these DMO plans are becoming less common because patients want to make their own decisions and are choosing to pay for them less and less. Finally, there are a few “discount plans” out there that are not really insurance. Basically, you pay a third party for a list of doctors willing to discount their fees. The lists you receive are often incomplete and change on a frequent basis.
Other than the above three, any other insurance (commonly called PPO or “conventional” plans) can be filed by any dentist. Modern computer software allows us to calculate estimated copays and patient portions on the spot. With the correct information from your insurance company, we can accurately predict what they will pay for most any procedure. This allows us to discount what the insurance is estimated to pay from your treatment fees. After treatment, we can then send everything electronically so that there are no forms for patients to hassle with. Sometimes, technology really can make life easier.
A disclaimer here…I cannot speak for all dentists on this subject because there are a variety of ways to handle dental insurance. I can only describe how we handle dental insurance in a single office in Llano. I can say that our method is quite common.
Until next week, keep smiling.
-Please send questions to Drs. Parrish at www.ParrishDental.com.