Dental Insurance FAQ: Getting the Most From Your Dental Plan - YouTube

Hi I'm Dr. Nicole Vane, the owner of Moonlight  Deach Dental, general, integrative and biologic  

dentistry. And this video is on a rather  frustrating topic: Why we are dropping a  

lot of PPO dental insurances. We're not dropping  them per se, we're going out-of-network. What  

does that even mean? With all the political  talk right now about health care, Obamacare,  

what not, be aware that healthcare and dental  health care benefits are changing. I've been  

practicing for over 15 years, and the amounts  that were paid for a procedure are the same  

or less than they were 15 years ago, which is  pretty staggering. Now as a biologic dentist,  

and I'd like to admit, a very high-tech dentist, I  use nothing but the best materials. I have a very,  

very expensive 3D CAD CAM machine, we have lasers,  we have the lowest radiation, brand-new digital  

radiography units, we have aromatherapy, we have  a lot of things that we offer in this office that  

we're not paid for. The burden as a business owner  is that I'm actually losing money treating a lot  

of patients in-network. Believe it or not, some  exams for me to spend an hour with a patient,  

I'm reimbursed $17. Now some patients are like,  'Yes she gets $17 but then they probably the  

insurance kicks in another $300!' No, I literally  get $17. So not only is my time free, I'm actually  

losing money on the assistant sitting next to  me who's charting. That's rather frightening.

Also with the dental materials. We're paid  so little that, because I use such high-end  

materials, I actually break even with what the  insurance reimburses me just on my material  

costs which means, again, I'm working for  free. I don't like to rush my procedures. I  

love to spend time with my patients. I love to  do a really thorough new patient intake exam.  

And instead of shortening it to 5 minutes, which  is what insurance would require, and having six  

patients in the waiting room all waiting an hour  each - I can't afford to do it for $17 an hour.

Now what does this mean? I'm not going to  change the way I practice. What's going to  

make this practice right for you is someone who  really values having the best of everything,  

at a reasonable, affordable price! We haven't  raised our fees at all. We're actually very low  

for our area. We're in the 70th percentile for  our area. So I want to make dentistry affordable,  

and what it means being out-of-network means  that we will still bill your insurance,  

we will get insurance breakdown, we're  well versed and all of your insurance  

needs and requirements, and we'll  submit the claims for you. However,  

they're going to reimburse us at  our fee versus the fee they've set.

For example: A crown typically is about  $1100, $1200. Insurance will only pay us  

$598 in-network. And then, if you get half of  that paid for by insurance, your co-payment  

would be about $300. So now you would have  a slightly larger co-payment, the insurance  

would still pay for half of the crown, it would  just be it our set fee versus the fee of $600.

So now you're saying, 'Oh gosh, well now  I can't even go to the dentist... I can't  

go to the dentist because she's going to  charge me so much money.' That is the most  

common misconception people have when they  hear "out-of-network". Now other than HMO,  

which is where you're required to see a  dentist has to be on their network paperwork,  

who is in-network with HMO. With PPO insurances  you can go wherever you want, and you can pay  

just a little more out-of-pocket. Sometimes  it's as little as 10% more. It's not double,  

it's not triple, it's not quadruple.  It literally is as little as 10% more.

The other thing to consider is that I'm a really  conservative dentist, who... I really pride myself  

on being a patient advocate. So part of that is,  in order to compensate for low fees, I'm not going  

to upsell you on anything. I'm not going to tell  you about stuff that you need or don't need, I'm  

just going to tell you about what's important for  your health, and then we'll have a conversation  

about what might be needed in the future.  So instead of having a big dental bill dump,  

which is what most people anticipate when they go  to the dentist, what they don't realize is that a  

lot of these in-network low network PPO insurance  practices are driven with a practice model where  

they have to upsell you on stuff. So there's  so many hidden charges on things. It's kind  

of like you know you buy your airline ticket  now they're going to charge you for a snack,  

and for your bag, and based on your bag weight.  And they're trying to essentially just recoup  

some of their costs to try and keep it competitive  fare. In dentistry it's the same thing. There's a  

lot of unnecessary charges at every single  procedure that dentists tack on, just so  

they can try and build up the fee to something  close to what they need to stay in business.

So essentially in order to  give people the best care,  

we are still in-network with several  insurances but we'll be out-of-network  

with those we accepted previously  that just have too low of a fee.

The other complicated thing is that my referral  specialists, I work very closely with a specific  

team of highly trained oral surgeons,  root canal specialist if you need one,  

periodontal specialists that are very aligned  with my way of thinking. And they're also very  

conservative and they have an excellent  chairside manner. None of them anymore  

are taking some of these insurances because for  them the reimbursement is also so low. So then  

patients are just left going to the telephone book  in the old-fashioned way or essentially Googling  

who's going to take their insurance, calling  their insurance network, and then randomly  

throwing a dart at the dartboard to figure out  who's going to take their insurance from them.

So essentially whatever someone needs, I'm  happy to talk to them about. We have a really,  

really great financial coordinator / treatment  planner that can explain all of your options  

and give you a very clear estimate of what  your dental insurance is going to pay for  

and what your out-of-pocket will be. It'll also  show you what the hidden downgrade fees are,  

meaning that instead of a white filling  insuranceswill still only pay sometimes  

for a mercury filling, or instead of a white  crown they'll only pay for a base metal or  

low base metal crown... they're going to go  over all those nuances about your insurance,  

so you really know what your out-of-pocket  would be. And again my only priority is the  

patient and patient care. It's not  the business of dental insurance.