Traditonal Coverage

Explanation of Traditional Coverage

Traditional coverage's are also referred to as indemnity plans. Generally speaking, the premium for a traditional type of plan is more expensive than that of a managed care plan or a PPO. Typically such plans do not require or provide monetary incentives to the policy holder to go to one specific doctors office or to choose from a catalog of a network providers.

It is also common that such plans contain one or both of the following limitations; an annual deductible amount and an annual maximum. These limitations can either be per person or per family. Per person is by far the more common variation. The purpose of deductibles is to dissuade casual use of benefits for patients prone to use their benefits for relatively minor problems and in the case of annual maximums to limit the insurance company's financial exposure for clients requiring extensive treatment.

The terms usual, customary and reasonable were also invented for use with these plans. Sometimes a particular insurer will substitute the term maximum allowable for the older UCR terminology. The definition of these terms are very loose in the insurance industry but their purpose is quite clear. By setting limits on the maximum amount that the insurance company will pay per each procedure they are able to further limit their exposure even when the policy holder does not utilize all of his annual maximum.

In addition, many of these plans also pay different percentages for different classes of procedures. The most common variation is 100 / 80 / 50, meaning that the insurance company will pay 100 percent on routine care such as periodic well care exams, radiographs, and simple dental prophylaxis (cleanings). 80 percent on common but more expensive procedures such as crowns (caps), bridgework and dentures, and only 50 percent of rarer more expensive procedures such as bone or skin grafting.

The traditional policy holder should always be aware of 3 very important facts.

1. Your plan was specifically designed (no matter how it was marketed) to never cover anything 100%. The simple reason for this is to deter the policy holder from utilizing their benefits.

2. It is illegal to accept insurance payment as payment in full for services rendered. Such practices are strictly enforced by insurers and are grounds for loss of licensure. The simple reason for this is that this practice encourages patients to utilize their benefits.

3. The terms usual, customary and reasonable are very carefully chosen marketing terms that do not represent any kind of mean, average or other mathematical calculation or census of fees that are actually charged by dentists for their work. Every insurance company has different UCR tables and most have several different tables that they use depending on how they are attempting to market a particular plan. Furthermore insurance companies are not restricted in any way from changing the UCR figures daily or even minute to minute. Finally, Dentists are not allowed to know what the UCR or maximum allowable fees are for any procedure. (It can be deduced only when the fee charged is over the maximum). The simple reason for this is that the few dentists who may be legitimately charging less than that amount might be encouraged to raise their fee for that procedure to the maximum.

4. Co-payments, like deductibles, are carefully calculated to be just high enough to deter most insured persons from utilizing their coverage. When you defer or ignore needed treatment because of co-payments, you are behaving exactly as your insurance company hopes that you will.

As a Glick Dental Associates patient there is only one thing you need to know about our fees and traditional insurance.

At Glick Dental Associates, the fee charged is never changed from patient to patient depending on what their coverage will pay. Furthermore, our fees are set to allow for an appropriate and fair margin of profit that will allow us to continue to provide the very highest of quality of care, service and value to our patients. We feel that this is the only ethical way to do business and we will never compromise those values. Please do not embarrass us by asking us to do so.

Terms of Payment:

As a courtesy to our patients we will submit all insurance paper work on your behalf and wait the legally prescribed amount of time insurance companies have to pay a claim under Ohio Law. In return we ask that you please take care of at least half of your estimated personal obligation at the time services are begun and you may take up to 90 days from that date to complete payment for that treatment at 0.0% interest. If you require financing beyond the 90 days our staff may be able to arrange 6 month and 12 month no interest loans through an outside finance company. For your convenience we also take all major credit cards.

We gladly accept:

Please understand that the insurance industry is a highly unregulated industry and prone to very unethical practices and, therefore, we can not and will not guarantee our estimate of their contractual obligation to pay our office on your behalf. This means that if the insurance company does not pay, you are obligated for the full amount of the charges and it will be due and payable as soon as we are notified of the insurers denial of benefits.