Dr. Won Sung, DDS

Dental Insurance – Part 2

October 19, 2018
Posted By: Dr. Won Sung, DDS
Close Up of Medical Paperwork | Dentist Elgin IL

In Part 1 of this blog series about Dental Insurance, I explained a bit about different types of dental insurance plans and what being in-network and out-of-network mean. I will illustrate what sets my practice apart from my competitors and also introduce our Dental Savings Plan for patients with no insurance in Part 2. 

Dr. Sung, my insurance told me I can’t go to your office anymore. Is it true?

Unless you are covered by HMO plans that assign you to a specific doctor, you are free to select your own dental provider. There have been cases where insurance companies send letters out to plan subscribers or patients advising to select a network dentist in town. Also, the following is an excerpt from the Delta Dental website:

“Delta Dental Premier® and Delta Dental PPOTM plans allow you to select any licensed dentist. We recommend you select a Delta Dental dentist because you may enjoy lower out-of-pocket costs and Delta Dental dentists agree never to charge you more than the fees determined by Delta Dental. If you choose to visit a dentist outside of the Delta Dental network, you will likely have to submit claims yourself and pay the entire bill up front.”

Many dental professionals decide to stay out of network because we have one core belief in common – nobody other than licensed dentists should dictate and decide on treatment plans and service fees. Many insurance plans are really good at absurdly denying submitted claims saying “Your claim is denied because it appears to be unnecessary”. Who gets to decide the necessity of proposed treatment? Someone who invests years of post-secondary education and training to obtain a doctor’s degree or a customer service rep with no medical or dental background but a few weeks of training requiring them to deny certain % of claims?

It is disheartening to witness how badly dental insurance companies influence people’s perception of dentists. It almost sounds like “Go to in-network dentists. They are nice enough to keep their fees low“. The medical field and their affiliation with insurance companies is a totally different area of concern, but when it comes to dentistry and oral health, all I want to mention to patients is to stay with the dental provider that you have trust and confidence in regardless of insurance participation.             

Why should I go to your office? What sets you apart from many other dentists in town?

  1. My office is out of network with all plans which means we are not dictated by the policies set by insurance companies and do not get reimbursed at low, contracted fees most PPO offices accept. We still handle all claims for our patients as a courtesy and accept all traditional indemnity plans and PPO plans as method of payment. Unless agreed otherwise, insurance claim will be billed to the insurance and once insurance payment is collected, the difference becomes patients’ responsibility. Also, it’s not guaranteed but when necessary, we submit to your insurance companies to obtain pre-treatment estimates on larger cases such as crowns, bridges and dental implants.      
  2. All my routine care patients are scheduled for one hour for their visits. This gives my hygienists and myself enough time to do thorough exams and cleanings.  Sometimes we run behind due to unforeseen circumstances, but we never try to rush. We do our best to make patients feel comfortable and pleased. Some PPO-driven practices allow only 40-45 minutes per patient. The work that requires at least an hour now has to be done in a shorter amount of time, and that includes breaking down and setting up dental operatories in between patients!   
  3. We educate our patients and try to be conservative. I utilize modern dental intraoral imaging and digital x-ray technology to educate patients. My staff and I inform patients what we observe and offer treatment options when clinically necessary. For example, some small caries that are present only on enamel, the most outer layer of the tooth, will most likely be watched if that patient has been cavity free for many years. If the carious lesion is progressively getting bigger over time, treatment options will be discussed with the patient. Some teeth with old amalgam restorations tend to show crack lines due to weakened tooth structure. Unless they become symptomatic or fracture into pieces, teeth are being monitored and evaluated periodically. Depending on the dental history of the patient, certain treatment can be proactively and strongly advised. 
  4. We are trustworthy. No gimmicks! No upselling! We treat you like family members and everything we do and recommend is in your best interests. Enough said. 

Dr. Sung, I don’t have any dental insurance. What do I do now?

In my previous blog, Dental Insurance - Part 1, I described how different plans work. While being insured certainly helps, dental insurance does not really ensure you 100%. It is more like a limited benefit with unreasonable restrictions.   

My office proudly presents our in-house dental membership called “Dental Savings Plan”. For a single person, the annual plan fee is $380. This annual enrollment fee covers two exams, two cleanings, a set of bitewing x rays, and a fluoride varnish treatment, and you have one year from the date of your enrollment to enjoy this great benefits. Also, a full mouth x-ray series ($150 value) is included with no additional cost. In addition, dental procedures are discounted 10-15% from the regular fees.  Detailed plan brochure can be accessed by clicking here. 

The emphasis of this plan is on allowing routine dental exams and treatments affordable and accessible to those who are uninsured and having them return regularly as prevention is the best way to maintain great oral health. If you have any questions, feel free to contact my Elgin IL dental practice at 847-741-4347 to discuss your options on affordable dental care!       

This concludes Part 2 of Dental Insurance Blog. By writing these blogs, I hope you realize that oral health is the gateway to your overall well-being and having someone you trust and respect as a dental provider is more important than chasing after the deal or free gifts. Thank you for your time to read this far!  

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