Patients without dental insurance no longer pay more than those with dental insurance. We have created a fee schedule that allows cash paying patients to pay the same amount as our insured patients. This is the first of its kind and a major step forward in making dentistry available and affordable for everyone.
We decided to take these unprecedented steps because we saw and felt the increasing frustration that patients experienced when dealing with their insurance companies. Patients are paying $500-$1000/year for their insurance and only getting the benefit of 2 cleanings per year. If any restorative work needed to be done, they were on the hook to pay anywhere from 20-50% (co-insurance) additional.
Basically, dental insurance has become a payment plan for dental care. If you fail to get your 2 cleanings per year, you essentially throw that money away. If you need any work done, you still have to pay for a good portion of it that insurance refuses to cover. Even worse, if a lot of work needs to be done, insurance carries a max benefit and will not pay anything over that limit. Why bother?
From our billing perspective, we often times will have dental work pre-authorized from an insurance carrier only to have them turn around and refuse to cover the work. You can only imagine the frustration when that burden then falls back on a patient that was expecting their insurance to cover treatment.
Enough is enough. Let’s make this work for everyone!
Read below to see a few examples of how this worked.
*Patient 1 (Jane): Jane, who is uninsured, came in for her routine visit and discovered that she had a cavity. Rather than pay the UCR Fee (the fees established by an office as usual and customary) of $300, Jane only had to pay what another patient that does have dental insurance pays. In this case, the same filling for that cavity for the insured patient would have been $240. This is because a dental office is forced by the insurance company to accept the fees they deem appropriate, So, if insurance is only going to pay $240, then let’s allow everyone to only pay $240 whether they have insurance or not.
*Patient 2 (Mark): Mark does not have dental insurance, but comes in 2x per year for his cleanings, exam, and xrays. The amount paid based on the UCR Fee schedule was $89/$70/$72 (cleaning/exam/xrays) for a total of $231. Mark needs no additional work as he always has very good oral hygiene. Insurance would reimburse the office $79/$50/$42 for these same services for a total of $171. Going forward, Mark now pays the same as the insured reimbursement rate.
*not actual patients.
***** The Fee Schedule was established and adopted based on the average reimbursements from a variety of different insurance companies. Some insurance will reimburse our office a higher amount than our in-house cash plan and some will reimburse a lower amount.